Browsing by Author "Peško, Predrag M. (7004246956)"

Background: Endoscopic mucosal resection and submucosal dissection (ESD) are indicated in a majority of mucosal esophageal, esophagogastric junction and gastric cancers (GC), and selected cases of submucosal cancers as well. Summary: The presence of lymph node metastases in early esophageal cancer (EC) has been proven in up to 50% of-patients with sm3 cancers treated with surgical resection, and up to 18.5 and 30.5% in sm1 and sm2 cancer respectively. The presence of lymphovascular invasion (LVI), tumor depth >500 μm and poor tumor differentiation seem to be a common predictor of worse outcomes in literature reports. In case of early esophagogastric junction cancer (EGJC) these predictors include LVI, tumor size >3 cm, Barrett's origin of the tumor and ulcerative tumor appearance. Extended indications for ESD in early GC are already adopted in high volume centers with high success rates (up to 98%). Jet, positive resection margins after ESD, LVI and poor tumor differentiation carry high metastatic potential, therefore advocating surgery. Limited resections and cooperative laparoscopic endoscopic approach may be implemented in cases of early EGJC and GC. Key Messages: The presence of LVI, depth of submucosal invasion, and poor tumor differentiation in cases of early EC, EGJC, and GC favor surgical treatment despite improvements in endoscopic techniques. © 2018 S. Karger AG, Basel.

Background: Ineffective esophageal motility (IEM) in patients with gastroesophageal reflux disease includes three different subsets that may affect symptom profiles. Our aim was to assess symptoms and functional outcome in patients with erosive esophagitis according to different subsets of IEM, before and after Nissen fundoplication (NF).; Methodology: A retrospective study with prospective follow-up of 72 patients with reflux esophagitis and IEM in whom open NF was performed. Based on principal manometric esophageal body motility disorder, patients were divided in three groups: predominantly low-amplitude (LAC, N = 38), non-propulsive (NPC, N = 18), and simultaneous low-amplitude esophageal contractions (SC, N = 16). Patients underwent symptomatic questionnaire and stationary esophageal manometry before and 6 months, 1 year, and 3 years after surgery.; Results: Preoperatively, patients in NPC and SC groups had higher mean scores of dysphagia, without statistical significance as opposed to the LAC group (p = 0.239). Postoperative dysphagia occurred in 36 patients, without statistical significance between groups regarding dysphagia grades (p = 0.390). A longer duration of postoperative dysphagia was noted in the SC group (p < 0.05). Improvement of nadir values of contraction amplitudes in distal esophagus occurred postoperatively in all groups, significantly higher in LAC (p < 0.001).; Conclusion: Three years after NF, successful symptomatic and functional outcome was achieved in analyzed groups of patients with erosive esophagitis regardless of IEM subtype. © 2014, The Society for Surgery of the Alimentary Tract.

Endoscopic radiofrequency ablation (RFA) today represents a well-established, safe and effective procedure for the treatment of Barrett's esophagus (BE). Choice of additional treatment to RFA emerges as an important clinical issue, due to the fact that recurrence of BE after complete eradication (CE) of intestinal metaplasia (IM) or dysplasia may occur. Concerning the data available so far, recurrence may occur due to insufficient reflux control with standard PPI's regimen, while those with large hiatal hernia and long segment BE represent the subgroup of patients at highest risk for recurrence. Due to the anatomical deviation in distal esophageal segment proper ablation may be difficult in such patients. These patients can be treated by employing concurrent ARS and RFA. Concurrent ARS and RFA was proven to be safe, not time consuming, and it can be performed in conjunction with the basic rules of RFA procedure. Early results, in term of enhanced healing of treated epithelium, and possible reduction in number of ablation sessions needed to achieve CE of IM or dysplasia, are promising. To conclude, antireflux surgery may have important role in some patients undergoing RFA, especially those with significant hiatal hernia and anatomical impairment in distal esophageal segment. © 2021 Annals of Esophagus.

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