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Best Practice & Research. Clinical Gastroenterology

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https://www.readbyqxmd.com/read/30551864/palliation-of-dysphagia
#1
REVIEW
R D van der Bogt, B D Vermeulen, A N Reijm, P D Siersema, M C W Spaander
Palliation of dysphagia is the cornerstone of palliative treatment in patients with incurable oesophageal cancer. Available palliative options for dysphagia are oesophageal stent placement and radiotherapy. In general, oesophageal stent placement is the preferred therapeutic option in patients with a relatively poor prognosis because of its rapid relief of dysphagia. Regardless of ongoing technical developments, recurrence of dysphagia and stent-related complications are still occurring. For patients with a relatively good prognosis, intra-luminal brachytherapy is advised because of its sustained palliation of dysphagia...
October 2018: Best Practice & Research. Clinical Gastroenterology
https://www.readbyqxmd.com/read/30551863/the-role-of-surgery-in-advanced-disease-for-esophageal-and-junctional-cancer
#2
REVIEW
Stefan Mönig, Sander van Hootegem, Mickael Chevallay, Bas P L Wijnhoven
The incidence of esophageal and junctional cancer has been increasing in western industrialized nations in the past 30 years. At the time of diagnosis, approximately 50% of patients with esophageal and junctional cancers have distant metastases and are considered incurable. In the recent ESMO guidelines and the German S3 guidelines, surgical therapy for metastatic disease is not recommended. In spite of these recommendations, the treatment of limited metastatic (oligo-metastastic) esophagogastric cancer is currently undergoing a shift towards a more aggressive therapy...
October 2018: Best Practice & Research. Clinical Gastroenterology
https://www.readbyqxmd.com/read/30551862/molecular-pathways-in-the-development-and-treatment-of-oesophageal-cancer
#3
REVIEW
Robert Charles Walker, Timothy James Underwood
The molecular pathways involved in the development and treatment of oesophageal cancer are complex. Recent large-scale genome sequencing studies have delivered novel insights into aetiology and possible targeted treatments. Oesophageal squamous cell carcinoma (OSCC) and adenocarcinoma (OAC) are distinct entities. At the molecular level OSCC is more similar to squamous cell cancers in other organs than OAC. Whilst considerable heterogeneity exists in both tumour types new data suggests that driver gene events and mutational signatures may be able to categorise tumours into potentially actionable subtypes...
October 2018: Best Practice & Research. Clinical Gastroenterology
https://www.readbyqxmd.com/read/30551861/the-management-of-mid-proximal-oesophageal-squamous-cell-carcinoma
#4
REVIEW
Ian Wong, Simon Law
Despite the rise in incidence of adenocarcinoma, squamous cell cancer of the oesophagus remains the commonest cell type worldwide and is predominant in the East. Except for very early tumours where endoscopic therapy can be performed with curative intent, in more advanced but potentially curative cancers, treatment for mid and upper third tumours is primarily surgery with extended lymphadenectomy, together with multimodal therapies such as preoperative chemotherapy or chemoradiotherapy. Definitive chemoradiotherapy is utilized in those who decline surgery or in those who are unfit for major procedures...
October 2018: Best Practice & Research. Clinical Gastroenterology
https://www.readbyqxmd.com/read/30551860/robot-assisted-minimally-invasive-esophagectomy-ramie-for-esophageal-cancer
#5
Pieter Christiaan van der Sluis, Richard van Hillegersberg
Worldwide, the standard treatment for locally advanced esophageal cancer with curative intent is perioperative chemotherapy or preoperative chemoradiotherapy followed by open transthoracic esophagectomy (OTE) with gastric conduit reconstruction. Minimally invasive esophagectomy (MIE) was developed to improve the postoperative outcome by reducing the surgical trauma, with comparable short-term oncologic results. However, MIE is a highly complex procedure associated with a long learning curve. In 2003, robot-assisted minimally invasive thoraco-laparoscopic esophagectomy (RAMIE) was developed to overcome the technical limitations of MIE...
October 2018: Best Practice & Research. Clinical Gastroenterology
https://www.readbyqxmd.com/read/30551859/oesophagectomy-the-expanding-role-of-minimally-invasive-surgery-in-oesophageal-cancer
#6
REVIEW
J W van den Berg, J D Luketich, E Cheong
Historically, open oesophagectomy was the gold standard for oesophageal cancer surgery. This was associated with a relatively higher morbidity. In the last two decades, we have seen significant improvements in short and long term outcomes due to centralisation of oesophagectomy, multidisciplinary approach, enhanced recovery after surgery programmes, neoadjuvant treatments and advances in minimally invasive oesophagectomy (MIO) techniques. MIO has significantly reduced postoperative morbidity and improved functional recovery, while maintaining comparable long-term oncological outcomes...
October 2018: Best Practice & Research. Clinical Gastroenterology
https://www.readbyqxmd.com/read/30551858/peri-operative-patient-optimization-for-oesophageal-cancer-surgery-from-prehabilitation-to-enhanced-recovery
#7
REVIEW
J Zylstra, P Boshier, G P Whyte, D E Low, A R Davies
No abstract text is available yet for this article.
October 2018: Best Practice & Research. Clinical Gastroenterology
https://www.readbyqxmd.com/read/30551857/the-role-of-definitive-chemoradiation-in-patients-with-non-metastatic-oesophageal-cancer
#8
REVIEW
Paul M Jeene, Hanneke W M van Laarhoven, Maarten C C M Hulshof
Definitive chemoradiation (dCRT) is a curative treatment option for patients with oesophageal cancer. It is effective in both adenocarcinoma and squamous cell carcinoma. However, locoregional control is less after dCRT compared to preoperative CRT (pCRT) followed by surgery. Also, overall survival is lower compared to pCRT followed by surgery, which can only partly be explained by a negative selection of patients. The optimal dose of radiotherapy remains to be determined, but dose escalation above 50.4Gy might be beneficial...
October 2018: Best Practice & Research. Clinical Gastroenterology
https://www.readbyqxmd.com/read/30551856/chemotherapy-and-novel-targeted-therapies-for-operable-esophageal-and-gastroesophageal-junctional-cancer
#9
REVIEW
Tom van den Ende, Elizabeth Smyth, Maarten C C M Hulshof, Hanneke W M van Laarhoven
During the past decades, several treatment strategies such as neoadjuvant chemotherapy, neoadjuvant chemoradiotherapy and perioperative chemotherapy have been shown to improve the prognosis of resectable esophageal cancer. Patients with squamous cell tumors respond better to neoadjuvant chemoradiotherapy compared to adenocarcinoma. Therefore, in squamous tumors neoadjuvant chemoradiotherapy is the preferred strategy. Neoadjuvant chemoradiotherapy and perioperative chemotherapy are both effective in patients with adenocarcinoma...
October 2018: Best Practice & Research. Clinical Gastroenterology
https://www.readbyqxmd.com/read/30551855/neoadjuvant-chemoradiotherapy-for-resectable-oesophageal-cancer
#10
REVIEW
B M Eyck, B J van der Wilk, S M Lagarde, B P L Wijnhoven, R Valkema, M C W Spaander, J J M E Nuyttens, A van der Gaast, J J B van Lanschot
At present, treatment of potentially curable oesophageal cancer includes neoadjuvant chemoradiotherapy followed by oesophagectomy. Alternatively, neoadjuvant chemotherapy is used. To date, strong evidence on the superiority of one modality over the other has not been provided. Currently, up to one-third of patients show a pathologically complete response after neoadjuvant chemoradiotherapy. To optimise the efficacy of neoadjuvant treatment for individual patients, prediction of response to neoadjuvant treatment is highly desired...
October 2018: Best Practice & Research. Clinical Gastroenterology
https://www.readbyqxmd.com/read/30551854/risk-factors-for-oesophageal-cancer
#11
REVIEW
Shao-Hua Xie, Jesper Lagergren
The two main histological subtypes of oesophageal cancer, squamous cell carcinoma and adenocarcinoma, have distinct risk factor profiles. For oesophageal squamous cell carcinoma, tobacco smoking and excess alcohol use are the main risk factors. For adenocarcinoma, gastro-oesophageal reflux disease and obesity are main risk factors, whereas tobacco smoking is a moderately strong risk factor and infection with Helicobacter pylori decreases the risk. Dietary factors may influence the risk of both types of oesophageal cancer...
October 2018: Best Practice & Research. Clinical Gastroenterology
https://www.readbyqxmd.com/read/30551853/endoscopic-management-of-dysplasia-and-early-oesophageal-cancer
#12
REVIEW
S S Zeki, J J Bergman, J M Dunn
In the past decade there have been technological advances in Endoscopic Eradication Therapy (EET) for the management of patients with oesophageal neoplasia and early cancer. Multiple endoscopic techniques now exist for both squamous and Barrett's oesophagus associated neoplasia or early cancer. A fundamental aspect of endotherapy is removal of the target lesion by endoscopic mucosal resection, or endosopic submucosal dissection. Residual tissue is subsequently ablated to remove the risk of recurrence. The most validated technique for Barrett's oesophagus is radiofrequency ablation, but other techniques such as hybrid-APC and cryotherapy also show good results...
October 2018: Best Practice & Research. Clinical Gastroenterology
https://www.readbyqxmd.com/read/30551852/novel-imaging-techniques-in-staging-oesophageal-cancer
#13
REVIEW
Kieran Foley, John Findlay, Vicky Goh
The survival of oesophageal cancer is poor as most patients present with advanced disease. Radiological staging of oesophageal cancer is complex but is fundamental to clinical management. Accurate staging investigations are vitally important to guide treatment decisions and optimise patient outcomes. A combination of baseline computed tomography (CT), endoscopic ultrasound (EUS) and positron emission tomography (PET) are currently used for initial treatment decisions. The potential value of these imaging modalities to re-stage disease, monitor response and alter treatment is currently being investigated...
October 2018: Best Practice & Research. Clinical Gastroenterology
https://www.readbyqxmd.com/read/30551851/preface-oesophageal-cancer
#14
EDITORIAL
Bas Wijnhoven, Andrew Davies
No abstract text is available yet for this article.
October 2018: Best Practice & Research. Clinical Gastroenterology
https://www.readbyqxmd.com/read/30343715/risk-stratification-and-prognostic-modelling-in-primary-biliary-cholangitis
#15
REVIEW
Jorn C Goet, Maren H Harms, Marco Carbone, Bettina E Hansen
Primary biliary cholangitis (PBC) is a slowly progressive chronic cholestatic liver disease that, in a subgroup of patients, may result in liver failure or death. The definition of specific risk profiles, i.e. risk stratification, is of critical importance for the identification of these subgroups and thereby the targeting of care. Over the last few years large multicentre cohort studies have improved our knowledge regarding factors associated with progressive disease. Stratification based on biochemical response to ursodoxycholic acid provides a readily available measure to identify groups that might benefit from additional therapies to further improve prognosis...
June 2018: Best Practice & Research. Clinical Gastroenterology
https://www.readbyqxmd.com/read/30343714/improving-prognosis-in-primary-biliary-cholangitis-therapeutic-options-and-strategy
#16
REVIEW
Maren H Harms, Henk R van Buuren, Adriaan J van der Meer
Overall survival in primary biliary cholangitis is diminished. As patients are often asymptomatic, the disease may silently progress towards cirrhosis and liver failure. Timely diagnosis and effective treatment options are of vital importance to improve the prognosis of affected patients. Ursodeoxycholic acid is the standard of care first-line therapy and is associated with a reduced risk of liver transplantation and death. Treatment with UDCA is relevant for all patients, irrespective of disease stage or biochemical response...
June 2018: Best Practice & Research. Clinical Gastroenterology
https://www.readbyqxmd.com/read/30343713/patterns-of-disease-progression-and-incidence-of-complications-in-primary-biliary-cholangitis-pbc
#17
REVIEW
Ashnila Janmohamed, Palak J Trivedi
Clinical outcome for patients with primary biliary cholangitis (PBC) is dictated by development of cirrhosis, portal hypertension and its associated complications; including for some, a predisposition toward hepatocellular carcinoma. However rates of clinical progression vary, and accurately identifying disease course is of critical importance to patients, clinicians, as well as industry, who are committed to developing new effective and life-prolonging therapy as well as treating symptoms that appear disproportionate to underlying disease severity...
June 2018: Best Practice & Research. Clinical Gastroenterology
https://www.readbyqxmd.com/read/30343712/primary-biliary-cholangitis-and-bone-disease
#18
REVIEW
Albert Parés, Núria Guañabens
Osteoporosis, characterized by compromised bone strength leading to fragility fractures, is a common event in patients with primary biliary cholangitis (PBC). Osteomalacia, defined by poor bone mineralization is very uncommon. The pathogenesis of osteoporosis is not well clarified, but it mainly results from low bone formation. Few reports have revealed increased bone resorption, particularly in end-stage disease. The prevalence of osteoporosis is about 35% in the most significant studies, and it depends on the diagnostic criteria and severity of liver damage...
June 2018: Best Practice & Research. Clinical Gastroenterology
https://www.readbyqxmd.com/read/30343711/variant-syndromes-of-primary-biliary-cholangitis
#19
REVIEW
Lisa Schulz, Marcial Sebode, Sören A Weidemann, Ansgar W Lohse
Patients with primary biliary cholangitis (PBC) can show biochemical, serological and/or histological features of autoimmune hepatitis (AIH). The term 'AIH-PBC overlap syndrome' has been used frequently for these cases and implies the coexistence of two separate diseases. However, the boundaries between 'classical' PBC, PBC with features of AIH and 'classical' AIH are difficult to define, and therefore the term 'variant syndrome' should be preferred. A variant syndrome must primarily be assumed in PBC patients showing pronounced hepatitic activity, either expressed by elevated transaminases and raised levels of serum IgG/gammaglobulins or more specifically by liver biopsy showing a modified hepatitis activity index (mHAI) score of >4/18...
June 2018: Best Practice & Research. Clinical Gastroenterology
https://www.readbyqxmd.com/read/30343710/pbc-and-related-extrahepatic-diseases
#20
REVIEW
Annarosa Floreani, Nora Cazzagon
Patients with PBC have at least 60% of probability to have an autoimmune extrahepatic condition. The pathogenesis of these conditions includes a common mechanism involving both innate and adaptive immune responses targeting cholangiocytes and different extrahepatic tissues. The recent EASL guidelines recommend the management of these conditions, although detailed practical treatments have not been indicated. Autoimmune extrahepatic conditions may include: rheumatologic, endocrine, pulmonary, gastrointestinal, dermatologic diseases...
June 2018: Best Practice & Research. Clinical Gastroenterology
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