The proton pump inhibitors (PPIs) are extensively prescribed for the empirical treatment of epigastric pain and heartburn in cancer patients. However, they carry the potential for drug interactions with antineoplastic agents during active cancer therapy, and osteopenia, opportunistic infections, adverse cardiovascular outcomes, and altered gut microbiome in long-term users in survivorship. Herein, we examined the use of endoscopy with esophageal 96-hour ambulatory pH monitoring in guiding clinicians in safely prescribing PPI in 21 such patients. We retrospectively studied patients with active cancer or in survivorship, presenting with PPI-refractory heartburn. All underwent an endoscopy with esophageal ambulatory pH monitoring performed "off" PPI therapy for 96 hours, following a "liberal diet" for the first 48, and a "restrictive diet" for the latter 48 hours. Acid exposure time (AET) ≥ 6% per 24 hours was defined as abnormal. For each patient, the average AET from the first 2 days was considered as baseline and was compared with that from the latter 2 days (on restrictive diet). We concluded that ambulatory 96-hour pH monitoring, identifies 48% of patients with normal AET, who may not need PPI. Esophageal pH monitoring on restrictive diet normalizes AET in 73% of patients, thereby allowing esophageal acid control to be achieved with diet alone.

Empiric elimination diets remain a cornerstone of treatment for eosinophilic esophagitis (EoE). Immunoglobulin E (IgE) mediated allergic reactions have been sparsely reported during the food reintroduction phase, raising concerns both for patients and physicians. We aimed to assess the physician reported rates of new-onset IgE mediated reactions in EoE associated elimination diets (NIMREEDs), physician awareness of NIMREEDs, and how awareness impacts physician and patient treatment selection.

Patient-reported outcome measures (PROs) in eosinophilic esophagitis (EoE) have been utilized as research tools to assess outcomes in clinical trials. To our knowledge, adult and pediatric EoE PROs have not previously been analyzed from a health literacy perspective. We aimed to evaluate the readability of the most utilized EoE PROs for adult and pediatric populations and assess whether these PROs met national health literacy recommendations of readability at or below the sixth-grade level. We conducted a readability analysis of thirteen EoE PROs using four readability measures: Flesch-Kincaid Grade Level, Gunning Fog, Simple Measure of Gobbledygook, and FORCAST. Across these four individual metrics, the mean readability levels (years of education required) for PROs were 4.1, 5.5, 7.1, and 9.6, respectively. The four pediatric EoE PROs (PedsQL EoE module parent report for teens, PedsQL EoE module teen report, PEESS children and teen report, and PEESS parent report) included in this study had mean readability levels of 6.4, 6.2, 5.9 and 6.0, respectively. The nine included adult EoE PROs (EoE-QoL-A, BEDQ, DSQ, EoE-IQ, EEsAI, EoE-SQ, PiEAQ, PROMIS Scale v1.0-Gastrointestinal Disrupted Swallowing, and Straumann Dysphagia Instrument) had mean readability levels ranging from 5.3 to 8.7 with a standard deviation of 1.2. The average readability for all included EoE PROs was 6.6. In conclusion, current EoE PROs as research tools are slightly above recommended readability levels. Future EoE PRO development could be strengthened by using shorter sentences, writing for the target audience, and utilizing input from age-appropriate patients.

In esophageal squamous cell carcinoma, three-field lymph node dissection (3FLND) is not commonly performed after neoadjuvant chemoradiotherapy (nCRT) due to the high morbidity associated with the procedure and the poor long-term survival of patients with cervical/supraclavicular lymph node metastasis. This study aims to evaluate the long-term survival outcomes of patients who underwent 3FLND combined with nCRT.

Hospital-acquired pneumonia (HAP) is a common and challenging complication following esophagectomy, with definitions that vary widely across clinical and research settings. The Centres for Disease Control and Prevention (CDC) criteria are endorsed by international consensus groups as a reference standard, but their relevance in postoperative surgical populations remains uncertain. This study aimed to assess the diagnostic performance of alternative criteria, including the American Thoracic Society (ATS) guidelines, the Utrecht definition, and the Clinical Pulmonary Infection Score (CPIS), as well as clinical diagnoses made at our center, compared against the CDC definition. We conducted a retrospective review of all consecutive esophagectomies performed at a regional specialist center from 2014-2022. Data included patient demographics, comorbidities, imaging, and postoperative outcomes. The CDC criteria were used as the reference standard for HAP, against which the sensitivity and specificity of the ATS, Utrecht, and CPIS criteria, as well as clinical diagnoses, were evaluated. Among 460 patients, 223 (48.5%) were treated for HAP, but only 56 (12.2%) met CDC criteria. The ATS criteria demonstrated the highest agreement with the CDC definition (sensitivity 97.5%, specificity 92.0%), while the Utrecht and CPIS criteria showed lower specificity. Clinical diagnoses demonstrated high sensitivity (88.9%) but low specificity (50.1%) relative to CDC-defined HAP. The mean time to HAP diagnosis was 5 days (SD ± 3.7), and just over half of treated patients had positive sputum cultures. There is significant variability in HAP diagnosis following esophagectomy depending on which criteria are applied. Clinical diagnoses often exceed formal definitions, suggesting a risk of overdiagnosis and overtreatment. These findings support the need for tailored, consensus-based criteria to improve diagnostic accuracy, guide appropriate treatment, and enhance benchmarking across centers.

Lymphocytic esophagitis (LyE) is a novel rare esophageal disorder characterized by intraepithelial lymphocytic infiltration of the esophagus in a peripapillary distribution, without the involvement of granulocytes. The optimal treatment strategy for this condition remains uncertain. We aimed to synthesize the current evidence for the treatment of lymphocytic esophagitis.

Chemotherapy is indispensable to the treatment of esophageal cancer (EC), but its benefits in elderly patients remain unclear due to severe toxicity and side effects. The study aims to develop a risk-scoring model to predict which older patients are likely to benefit from chemotherapy. A total of 10,655 patients aged ≥70 years with pathologically diagnosed with EC were extracted from the Surveillance Epidemiology and End Results database, among whom 5,684 received chemotherapy. Sub-distribution hazard function were used to identify independent risk factors related to prognosis from the perspectives of the whole population, chemotherapy population, and non-chemotherapy population. Multivariate analyses based on the optimal model identified age, marital status, histology, tumor grade, T stage, N stage, M stage, lymph node positive rate, tumor size, surgery therapy, and radiotherapy as prognostic factors for elderly patients with EC. The concordance index of the best model was 0.772. X-tile software was utilized to classify the whole cohort into high-risk, medium-risk, and low-risk according to the total risk score. Sub-distribution hazard ratios was utilized to explore the effect of chemotherapy according to different risk stratifications. Chemotherapy did not impart a survival benefit to low-risk elderly patients with EC (Score ≤202), but did improve survival in patients in the medium-high risk groups (Score>202). Based on the results of the survival nomogram, a novel risk scoring system was constructed to screen for medium-high risk patients, for whom chemotherapy was more likely to bring additional benefit.

Chemoradiotherapy using proton beam therapy is a novel and promising option for patients with esophageal squamous cell carcinoma (ESCC) who do not prefer surgical treatment.

Barrett's esophagus (BE) is the only recognized precursor to esophageal adenocarcinoma, but progression risk is highly heterogeneous. While most patients with nondysplastic BE have an annual cancer risk less than 0.5%, a subset with dysplasia or adverse molecular profiles carries markedly higher risk. This variability necessitates precision risk stratification to optimize surveillance and intervention. We review the evolution of BE risk stratification from historical consensus frameworks to contemporary clinical, histologic, and molecular models. Key clinical predictors, validated scoring systems, and recent advances in biomarker-based and imaging-driven surveillance are summarized, with emphasis on their validation and clinical applicability. Established clinical risk factors-age, male sex, smoking, segment length, and dysplasia-remain central to risk prediction. Biomarker assays, including p53 immunohistochemistry, tissue systems pathology and methylation-based assays may provide risk stratification beyond histology. Advances in endoscopic imaging, wide-area transepithelial sampling, and non-endoscopic capsule-based collection platforms could transform surveillance into a risk-adapted paradigm. The management of BE is shifting from a one-size-fits-all surveillance model toward personalized, biomarker-guided care. Integration of clinical, histologic, and molecular data-underpinned by artificial intelligence and real-world validation-promises to refine surveillance, reduce overtreatment, and improve early cancer detection in Barrett's esophagus.

Esophageal high-resolution manometry (HRM) is the gold standard for evaluating esophageal motility disorders but can be limited by patient intolerance. With increasing use of glucagon-like peptide-1 receptor agonists (GLP-1RAs) for obesity and type 2 diabetes, delayed gastric emptying raises concerns for HRM feasibility and safety. This study assessed HRM tolerability in patients on GLP-1RAs. We conducted a retrospective case-control study of adult patients who underwent HRM at our tertiary care center between January 2014 and November 2024. Patients actively taking GLP-1RAs during HRM were identified as cases, while an equal number of consecutive eligible patients not on GLP-1RAs served as controls. Patients with established gastrointestinal dysmotility, prior foregut surgery, esophageal mechanical obstruction, large hiatal hernias, malignancy, or recent opioid use were excluded. From a prospective database of 7194 HRM attempts, 83 cases and 83 matched controls were identified. Among 166 patients, 15 (9.0%) had incomplete HRM due to intolerance, with similar rates between GLP-1RA users and controls (10.84% vs. 7.2%, P = 0.59). Predictors of incomplete HRM included younger age (44.9 ± 17.4 vs. 60.4 ± 13.7 years, P < 0.01), globus (P = 0.02), dyspepsia (P = 0.02), and depression (P = 0.04). No aspiration or adverse events occurred in either group. Duration of HRM before abortion was similar between cases and controls. GLP-1RA use was not associated with increased risk of HRM abortion or adverse events, suggesting these medications do not significantly impact HRM feasibility or safety.

Gastroesophageal reflux disease (GERD) imposes substantial global burden. Its recent trends and long-term projections have not been reassessed since the Global Burden of Disease (GBD) 2019 cycle. Using GBD 2021 data, incident and prevalent cases, years lived with disability, and age-standardized rates (ASRs) were estimated for 204 countries from 1990 to 2021. Decomposition analysis categorized changes into population aging, population growth, and epidemiological change. Projections to 2040 used a Bayesian age-period-cohort model, with Nordpred and ARIMA used to assess robustness. From 1990 to 2021, incident cases increased from 180.0 million to 324.1 million (+80.1%), and prevalent cases increased from 450.8 million to 825.6 million (+83.2%). The global age-standardized incidence rate (ASIR) reached 3882 per 100,000 with a peak at ages 30-39 years. ASRs varied by Socio-demographic Index (SDI) levels and exhibited a non-linear negative association overall: decreases at SDI <0.4 and > 0.6, with modest increases at 0.4-0.6. Decomposition analysis indicated population growth contributed most to the incidence increase (+95%), with smaller contributions from aging (+3%) and epidemiological change (+2%). Projections suggest that ASIR will increase to approximately 3939 per 100,000 and ASPR to approximately 9990 per 100,000, whereas ASYR is projected to increase only slightly. Projections were consistent across models. The global burden of GERD continues to rise, primarily associated with demographic expansion and modifiable lifestyle factors. In the absence of enhanced prevention, equitable diagnostic access, and obesity control, incidence and prevalence are anticipated to increase further through 2040. These findings provide region-specific evidence to inform resource allocation and targeted interventions.

Colonic interposition following esophageal resection remains challenging. Few studies have investigated the risk factors for postoperative complications and the prognostic factors in patients who underwent this type of surgery. We evaluated 83 patients who underwent esophagectomy with colonic interposition for esophageal and esophagogastric junction cancers. We analyzed factors associated with postoperative complications using logistic regression analysis and prognostic factors using Cox regression analysis. Postoperative complications occurred in 53.0% of patients, including anastomotic leakage in 22.9%, pneumonia in 19.3%, superficial surgical site infection in 7.2%, and deep surgical site infection in 7.2%. Preoperative malnutrition (odds ratio 5.31, 95% confidence interval 1.64-20.1, P = 0.005), synchronous gastrectomy (odds ratio 7.46, 95% confidence interval 2.15-31.5, P = .001), and upper (odds ratio 4.79, 95% confidence interval 1.05-25.1, P = .044) and middle (odds ratio 2.96, 95% confidence interval 1.01-9.33, P = .049) tumor locations were significantly associated with a higher incidence of postoperative complications. In addition, postoperative complications were independently associated with poor overall survival (hazard ratio 2.17, 95% confidence interval 1.13-4.17, P = .021) and cancer-specific survival (hazard ratio 2.52, 95% confidence interval 1.05-6.04, P = .039). Preoperative malnutrition, synchronous gastrectomy, and upper and middle tumor locations were independent risk factors for postoperative complications. Reducing the incidence of postoperative complications may contribute to improved long-term outcomes.

Esophageal squamous cell carcinoma is a major global health challenge in its locally advanced stages. Neoadjuvant chemoimmunotherapy aims to downstage tumors before surgery, but the optimal number of cycles remains uncertain. We performed a single-institution retrospective study of 208 consecutive patients with resectable, locally advanced esophageal squamous cell carcinoma treated between March 2020 and April 2024. Patients received either two (n = 84) or three (n = 124) cycles of platinum-based chemotherapy plus a programmed death-1 inhibitor, followed by esophagectomy without planned radiotherapy. Primary outcomes were pathologic complete response and disease-free survival; safety and clinical-to-pathologic downstaging were prespecified secondary end points. Three cycles yielded higher objective response (75.0% vs. 60.7%) and a higher pathologic complete response of the primary tumor (27.4% vs. 11.9%) than two cycles. Disease-free survival favored three cycles (hazard ratio, 0.52). Treatment-related adverse events occurred more often with three cycles, driven mainly by bone-marrow suppression (32.3% vs. 11.9%) but were generally manageable and compatible with timely surgery. Overall survival did not differ within the current median follow-up of 21 months. This retrospective analysis suggests that three cycles of neoadjuvant chemoimmunotherapy may provide greater tumor response and improved disease-free survival compared with two cycles in operable esophageal squamous cell carcinoma, with acceptable toxicity. However, neoadjuvant chemoradiation-which typically achieves higher pathologic complete response rates-remains the standard of care. Longer follow-up and prospective, stratified trials are needed to validate these findings and to define the role of a radiation-free strategy in appropriately selected patients.

Esophageal food impaction (EFI) is a gastrointestinal emergency that often requires urgent endoscopy. Predictors of recurrence and adverse events remain understudied and inconsistently reported. We conducted a systematic review and meta-analysis to identify predictors of recurrence and adverse events in EFI. We systematically searched PubMed, Embase, and the Cochrane Library on March 1, 2025. We included any observational studies or clinical trials that evaluated EFI outcomes in adults. The primary outcomes were EFI recurrence and adverse events, assessed according to underlying esophageal pathology, biopsy practices, follow-up, and timing of endoscopy. Effect sizes were evaluated using odds ratios (ORs), and a random-effects model was applied. A total of 14 studies were included with 3116 patients. Male gender was modestly associated with a higher risk of EFI recurrence (OR 1.45; 95% CI 1.01-2.10; P = 0.05), and patients with eosinophilic esophagitis (EoE) had a markedly increased risk of recurrence (OR 3.28; 95% CI 2.09-5.14; P < 0.001). No significant associations with recurrence were observed for biopsy (OR 1.44; 95% CI 0.98-2.11; P = 0.06), those who underwent follow-up (OR 1.10; 95% CI 0.37-3.32; P = 0.74), gastroesophageal reflux disease (GERD) (OR 1.22; 95% CI 0.46-3.23; P = 0.68), or hiatal hernia (OR 1.84; 95% CI 0.51-6.65, P = 0.35). For any adverse events, neither a history of prior EFI (OR 1.80; 95% CI 0.26-12.26) nor the timing of endoscopy (OR 0.89; 95% CI 0.49-1.64) was significantly associated with increased risk. Similarly, gender, EoE, and GERD were not associated with increased risk of adverse events. Only the male gender and EoE were significantly associated with a higher risk of EFI recurrence. Other factors, including GERD, hiatal hernia, follow-up, and biopsy status, were not. Delayed endoscopy and prior EFI were not associated with increased adverse events. Large-scale studies are needed to define risk factors better and strengthen the risk-stratification guide for preventive strategies.

Esophageal cancer (EC) remains a leading cause of cancer-related mortality worldwide. For patients with locally advanced, non-metastatic EC, advances in perioperative care, and surgical techniques have led to improved outcomes; however, significant variation persists, and standardization remains limited. This study aimed to characterize current practice patterns among expert surgeons at high-volume European centers through a structured, in-depth survey. Eight expert upper gastrointestinal surgeons from European centers performing >60 esophagectomies annually participated in comprehensive interviews. Topics included preoperative care pathways for distal esophageal/gastroesophageal junction adenocarcinoma, technical aspects of Ivor Lewis esophagectomy, and postoperative recovery protocols. Additional focus areas included multidisciplinary team involvement, allied health integration, research program participation, and follow-up strategies. Widespread agreement (7-8 of 8 centers) was observed in several domains: national EC care regionalization, multidisciplinary cancer conference review of all patients, institutional EC research programs, use of prospective national/international databases, application of CROSS chemoradiotherapy for squamous cell carcinoma, and perioperative FLOT chemotherapy for adenocarcinoma. Common surgical techniques included minimally invasive Ivor Lewis esophagectomy, two-field lymphadenectomy with en-bloc thoracic duct ligation, nasogastric tube placement, omental wrap of the anastomosis, and Enhanced Recovery After Surgery-based postoperative protocols. The majority of centers (5-6/8) performed routine preoperative optimization (nutrition, smoking cessation, frailty screening, oral hygiene/microbiome assessment), jejunostomy placement, and postoperative contrast swallow studies. Areas with notable variability (≤4/8 centers) included intraoperative crural closure, pyloric drainage procedures, gastric conduit sizing, postoperative pain management, and follow-up imaging timelines. High-volume European centers demonstrated strong alignment in several programmatic and perioperative elements of EC care, particularly around enhanced recovery pathways and preoperative optimization. Nonetheless, key intraoperative and postoperative variations persist, highlighting opportunities for future research, consensus building, and standardization to improve patient outcomes.

Transoral incisionless fundoplication (TIF) 2.0 using the EsophyX device is an increasingly recognized endoscopic treatment for symptomatic gastro-esophageal reflux disease (GORD). However, to date, there is no evidence on the learning curve for procedural efficiency and adoption into routine practice. In this UK-based, retrospective cohort study, we describe our single-operator learning curve and experience on procedural implementation following the introduction of TIF. Consecutive patients undergoing TIF were analyzed between 2019 and 2024. Patient demographics, baseline reflux assessments, and procedural details were recorded. The primary outcome was procedural efficiency and mastery based on a single operator learning curve using non-linear regression and CUSUM analysis. Secondary descriptive outcomes were technical success, change in clinical status, and adverse events. In total, 82 patients underwent TIF with a median age of 51 (IQR 37-64) and 28.1% were female. Technical success was 97.6% with an average procedure time of 48.9 minutes (SD 19.1). Procedural efficiency was achieved after 14 cases and mastery 35 cases. Among patients with ≥6-months follow-up (n = 58), 70.7% achieved a reduction in anti-acid therapy and/or quality of life score over 18.8 months (SD 9.9). Stratifying by our learning curve led to a non-significant improvement in symptoms at both procedural efficiency (n = 14; 64.3% vs 72.7%; P = 0.19) and mastery (n = 35; 62.9% vs 82.6%; P = 0.11). Adverse events were reported in 12.2% (6.1% AGREE grade IIIa). This study demonstrates the procedural learning curve required for efficiency and mastery of TIF2.0 and underscores the importance of collaboration between surgeons and endoscopists for successful service implementation.

High-resolution esophageal manometry (HRM) is the gold standard test for evaluation and diagnosis of esophageal motility disorders. While the Chicago Classification offers a standardized protocol for performing and interpreting HRM studies, it does not provide guidance on catheter placement techniques, nor the specific skillset required to conduct the test. At most centers nationally and globally, HRMs are performed by a trained nurse or medical technician. However, in selected centers, physicians perform HRMs alongside a clinical care assistant. Direct physician involvement in performing HRM offers unique clinical insights that can potentially enhance diagnostic accuracy, procedural efficiency, and patient experience. Based on our more than two-decade experience with physician-performed HRMs, we share various tips and techniques to provide step-by-step guidance on performing a high-quality HRM. In addition, we provide reflections from our experience on several benefits of physician-performed manometries including continued continuity of care, real-time interpretation with ability to perform adjunctive testing, and improved patient tolerance.

Patients after esophagectomy often face challenges in oral intake rehabilitation and nutritional management, which may affect rehabilitation outcomes. Semi-structured interviews were conducted with 15 patients during the oral intake rehabilitation period following esophagectomy, who attended follow-up visits between April and May 2025. The participants were 1 to 10 months post-surgery at the time of interview. All interviews were conducted face-to-face by a trained nursing postgraduate student experienced in qualitative research. The collected data were analyzed using Colaizzi's seven-step method. Four themes and eleven subthemes were identified: (i) Challenges in adapting to oral intake (forced changes in eating habits, prominent gastrointestinal discomfort, and negative emotions related to eating), (ii) coping strategies for oral intake difficulties (different perspectives on dietary practices during recovery, varied information-seeking channels, and differences in awareness of nutritional monitoring), (iii) existing barriers during the oral intake rehabilitation period (difficulties in food selection, ambiguous understanding of the timing of dietary transition, and challenges in calculating nutritional intake), and (iv) needs during the oral intake rehabilitation period (desire for more nutrition-related health education and demand for more accessible consultation platforms). Patients during the oral intake rehabilitation following esophagectomy face multiple barriers and needs. Healthcare professionals should place greater emphasis on patients' changes in eating habits, symptom burden, and psychological stress during the dietary transition, optimize pre-discharge education, develop dynamic nutritional intervention strategies, promote multidisciplinary collaboration, and establish digital information support platforms to meet patients' long-term nutritional needs.

We aimed to evaluate the demographic, clinical, procedural, and histopathologic factors associated with stricture development following esophageal endoscopic submucosal dissection (ESD). We conducted a retrospective cohort study of patients undergoing ESD for esophageal lesions from 2019 to 2024 at St. Michael's Hospital, in Toronto, Canada. The primary outcome was stricture formation, defined as a symptomatic luminal narrowing at the ESD site confirmed on follow-up endoscopy, requiring intervention. Strictures requiring dilation developed in 24% of patients, 85% of which were impassable with a standard gastroscope (9.9 mm diameter). Stricture rates increased with defect circumferential involvement: <50% (7.7%), 50%-74% (11.5%), 75%-89% (23.1%), and ≥90% (57.7%). Intraprocedural local triamcinolone acetate (LTA) injection was administered in 40 of 108 patients (37%), with a mean defect circumferential size of 87.5%. Among patients receiving LTA, stricture rates varied based on defect size: for <50% circumferential defect involvement (n = 1) and 50%-74% (n = 3), no strictures developed; for 75%-90% (n = 17), 6 patients (35%) developed strictures, 5 of which were impassable; and for 90%-100% (n = 19), 11 patients (58%) developed strictures, all of which were impassable. Patients selectively discharged on prophylactic steroids demonstrated varied stricture rates depending on the steroid regimen: prednisone (61.5%), oral budesonide (26.9%), and combination therapy (7.7%). Independent predictors of stricture formation included defect circumferential involvement (OR 1.07, 95% CI 1.03-1.12, p < 0.001), length of hospitalization (OR 1.88, 95% CI 1.11-3.16, p = 0.018), and presence of deep mural injury (OR 6.28, 95% CI 1.10-35.88, p = 0.039). Stricture formation post-ESD is strongly associated with lesion and procedural characteristics, including defect circumferential involvement, deep mural injury, and length of hospitalization.

Peroral endoscopic myotomy (POEM) has emerged as a minimally invasive alternative to laparoscopic Heller myotomy (LHM) for the treatment of achalasia. While short-term outcomes have been widely studied, evidence on long-term efficacy and safety remains limited and heterogeneous. This meta-analysis aimed to compare long-term clinical outcomes between POEM and LHM.