The role of postoperative radiotherapy after resection of esophageal small-cell neuroendocrine carcinoma remains uncertain. We evaluated associations with survival and recurrence while addressing treatment timing, confounding, and treatment-effect heterogeneity. We retrospectively analyzed 127 patients from three centers. Diagnosis required small-cell morphology plus synaptophysin and CD56 positivity. Radiotherapy and adjuvant chemotherapy were modeled as time-dependent exposures. Sensitivity analyses included a 90-day landmark design and propensity-score overlap weighting. Treatment-effect heterogeneity was assessed using interaction terms with Holm correction, and recurrence was analyzed using competing-risk methods. A cohort of 43 patients was analyzed descriptively. Radiotherapy was not associated with overall survival in the adjusted time-dependent model (hazard ratio, 1.472; 95% confidence interval, 0.820-2.641; P = 0.195), the 90-day landmark model (hazard ratio, 1.734; 95% confidence interval, 0.934-3.221; P = 0.081), or the overlap-weighted model (hazard ratio, 1.001; 95% confidence interval, 0.550-1.820; P = 0.999). Adjuvant chemotherapy showed a protective direction without statistical significance after adjustment (hazard ratio, 0.569; 95% confidence interval, 0.230-1.407; P = 0.222). No clinicopathological or biomarker-defined factor significantly modified the radiotherapy-survival association after Holm correction. First-failure patterns differed by radiotherapy status, with lower locoregional and higher distant-failure incidence among treated patients; these associations were descriptive because of residual treatment-selection bias. External-cohort estimates were nonsignificant and nonconfirmatory. This study did not demonstrate an overall survival benefit from postoperative radiotherapy and does not provide evidence supporting its routine use or patient selection based on nodal or biomarker status.

Pyloric management during esophagectomy remains controversial. Routine drainage may improve conduit emptying in some patients but exposes others to potential long-term symptoms including dumping syndrome and bile reflux. Conversely, omission of drainage avoids routine intervention but leaves a subset of patients requiring postoperative endoscopic treatment for delayed gastric emptying. The central problem is the lack of a validated method to identify, at the time of operation, which patients are likely to benefit from pyloric intervention. We describe early lessons from incorporating intraoperative impedance planimetry using EndoFLIP into minimally invasive esophagectomy. The assessment was performed as an incremental addition to routine on-table endoscopy after gastric conduit reconstruction. In 20 consecutive patients, pyloric distensibility index and diameter were measured at 30, 40, and 50 mL balloon fill volumes. Assessment was completed in all patients, added less than 10 minutes to operative time, and caused no device-related complications. Nine patients subsequently underwent postoperative pyloric dilation, most commonly for symptomatic delayed gastric emptying. These patients had lower intraoperative pyloric distensibility at 40 and 50 mL, whereas pyloric diameter did not differ between groups. Several lessons emerged: intraoperative pyloric impedance planimetry is feasible when intraoperative endoscopy is already part of routine workflow. Distensibility appears more informative than static diameter. Higher balloon fill volumes may better reveal clinically relevant differences. Finally, postoperative dilation is a pragmatic but imperfect endpoint because it is partly influenced by surgeon judgment and institutional practice. These observations support further prospective evaluation of intraoperative pyloric distensibility as a potential basis for selective, physiology-guided pyloric management.

Management of cT2N0M0 esophageal cancer is challenging due to staging limitations and limited evidence. While neoadjuvant therapies benefit advanced disease, its role in cT2N0M0 remains unclear, compounded by underrepresentation in trials and the differing responses to treatment between adenocarcinoma (EAC) and squamous cell carcinoma (SCC). To address this, the ISDE conducted a systematic review and meta-analysis comparing outcomes of neoadjuvant therapy plus surgery (NeoAdj+S) versus primary surgical resection (PSR). MEDLINE, EMBASE, and CENTRAL were searched to 25 November 2024 for English-language studies of adults (≥18 years) with EAC or SCC staged as cT2N0M0. Case series with ≤7 patients, recurrent disease were excluded. Two independent reviewers (YE, SL) selected studies, and extracted data. A random-effects meta-analysis was performed to assess outcomes. Of 299 unique articles screened, 18 studies were included, totaling 14,566 cT2N0 patients. Pooled analysis revealed no statistically significant differences between NeoAdj+S and PSR in terms of 5-year overall survival (OS) (RR 1.08, 95% CI 0.85-1.36; favoring NeoAdj+S), 3-year OS (RR 1.10, 95% CI 0.92-1.30; favoring NeoAdj+S); 5-year disease-free survival (RR 0.88, 95% CI 0.70-1.12; favoring PSR), 30-day mortality (RR 0.91, 95% CI 0.53-1.54; favoring NeoAdj+S), overall complication rates (RR 0.97, 95% CI 0.87-1.08; favoring NeoAdj+S); surgical complications (RR 0.92, 95% CI 0.78-1.08; favoring NeoAdj+S); or medical complications (RR 0.86, 95% CI 0.61-1.23; favoring NeoAdj+S). All included studies demonstrated high risk-of-bias. No clear survival or perioperative advantage was found for NeoAdj+S over PSR. High-quality clinical trials are needed to guide treatment decisions.

Standardized criteria for endoscopic assessment of the treatment response of esophageal squamous cell carcinoma (ESCC) are limited. The Japan Esophageal Society recently proposed the remarkable response, which is defined as marked tumor reduction with residual disease but an invasion depth equivalent to T1. However, its prognostic value has not yet been established. We aimed to evaluate whether remarkable response predicts survival outcomes of patients with esophageal squamous cell carcinoma. In this retrospective single-center study, we analyzed 300 consecutive patients with ESCC who underwent radiotherapy or chemoradiotherapy between March 2014 and March 2025. Patients were categorized into the complete response, remarkable response, or nonremarkable response group. The primary endpoint was overall survival. Survival outcomes were assessed using the Kaplan-Meier analysis and Cox proportional hazards models. The complete response, remarkable response, and nonremarkable response groups comprised 99, 116, and 85 patients, respectively. Overall survival (OS) was significantly better in the remarkable response group than in the nonremarkable response group. Outcomes of the remarkable response group were comparable to those of the complete response group. The 5-year OS rates were 79.4%, 61.0%, and 25.5% in the complete response, remarkable response, and nonremarkable response groups, respectively. In the multivariate analysis, the endoscopic response was an independent prognostic factor, and remarkable response was associated with a significantly reduced risk of death compared with that associated with nonremarkable response. Incorporation of remarkable response in the posttreatment endoscopic evaluation may support prognostic estimation and inform subsequent management.

Delayed gastric conduit emptying (DGCE) is a common functional complication after oesophagectomy, yet it remains inconsistently defined and managed. Although consensus diagnostic criteria are available, their incorporation into routine audit and the contemporary international patterns of DGCE-related practice have not been characterized. This study aimed to describe current international practice in the prevention, diagnosis and management of DGCE. A cross-sectional online survey was developed and distributed to surgeons performing oesophagectomy internationally through The Upper Gastrointestinal Surgical Society. The 55-item instrument captured practice patterns and perceptions relating to DGCE across the perioperative care pathway and during follow-up. Associations were assessed using Pearson chi-square and Fisher's exact tests. Two hundred and thirty surgeons from 57 countries responded. Fewer than one in five documented early (19.1%) or late (19.6%) DGCE using a standardized audit definition, and incidence was commonly perceived to be less than 10% for both. Prophylactic pyloric intervention was reported by 61.7% of respondents and varied significantly by operative platform, being more frequent among open and hybrid surgeons than minimally invasive or robotic surgeons (P = 0.013). Management of established DGCE was highly variable, with conservative and pharmacological measures predominating as first-line therapy and endoscopic pyloric interventions most commonly employed for refractory late DGCE. DGCE practice after oesophagectomy remains highly heterogeneous, shaped by institutional habit as much as by evidence. These findings support wider adoption of standardized DGCE definitions, incorporation of DGCE outcomes into institutional and national registries, and prospective trials comparing prophylactic pyloric strategies.

Eosinophilic esophagitis (EoE) is a chronic, immune-mediated disease whose incidence and prevalence have continued to rise, yet little is known about how public awareness has evolved alongside clinical progress. We used Google Trends, a freely available tool that indexes the relative popularity of search queries from 0 to 100, to examine interest in the terms 'eosinophilic esophagitis' and 'EoE' in the United States from January 2004 through December 2025, and to compare the disease term with searches for regulatory-approved EoE-relevant therapies (dupilumab/Dupixent, budesonide/Eohilia, and budesonide/Jorveza) in the United States and worldwide (English-language). Search interest for 'eosinophilic esophagitis' rose substantially across two decades (+2.97 points/year; P < 0.001), with segmented regression at clinical milestones showing significant slope changes at 2007, 2011, 2013, 2020, and 2024 (all P ≤ 0.04). Secondary analysis of the 'EoE' acronym corroborated these patterns, rising across the study period (+1.3 points/year; P < 0.001) with a final-year rise (+18.2 points/year). Searches for 'Dupixent' exceeded disease-term searches in both the United States and worldwide (English-language). Seasonal and monthly variation did not statistically differ. These observations illustrate how digital epidemiology has potential to serve as a low-cost barometer of disease awareness and information-seeking behavior. As patients increasingly turn from search engines to conversational artificial intelligence, these signals may evolve and further research is needed to define how digital epidemiology best be integrated with conventional epidemiologic data.

Barrett's esophagus (BE) is the only recognized precursor to esophageal adenocarcinoma (EAC). Endoscopic monitoring of BE allows for early detection and prevention against advanced cancer, which carries high morbidity and mortality. Over the past two decades, management of early EAC has shifted from esophagectomy toward organ-preserving endoscopic eradication therapy (EET), including endoscopic mucosal resection (EMR), endoscopic submucosal dissection (ESD), and ablative modalities such as radiofrequency ablation, cryotherapy, and hybrid argon plasma coagulation. EMR remains standard for most lesions with pre-invasive neoplasia and small intramucosal EAC, while ESD provides technical advantages for larger or complex neoplasia, though comparative long-term outcome data are limited. Ablation after resection achieves durable clearance of dysplasia and intestinal metaplasia, with emerging therapies showing promise in refractory or high-risk cases. Structured post-EET surveillance is critical, as recurrence risk is highest within 1-2 years of achieving remission, but persists at lower levels long-term. The risk of recurrence is influenced by lesion characteristics, treatment strategy, and center experience. Personalized, risk-adapted surveillance is increasingly supported, incorporating clinical factors such as BE length, baseline histology and prior treatment. More recently, molecular biomarkers and artificial intelligence (AI)-driven integration of clinical and genomic features have shown promising results. Future research should optimize tissue acquisition, refine biomarker panels, and validate AI-enabled predictive models to improve patient selection, minimize recurrence, and guide cost-effective, individualized care.

Eosinophilic esophagitis (EoE) and inflammatory bowel disease (IBD) are immune-mediated gastrointestinal disorders with a recognized epidemiologic association, yet the clinical phenotype of overlapping disease remains incompletely characterized. We performed a retrospective cohort study using the All of Us Research Program Controlled Tier dataset mapped to the Observational Medical Outcomes Partnership common data model. Adults with EoE were identified using International Classification of Diseases, Ninth Revision (ICD-9), International Classification of Diseases, Tenth Revision (ICD-10), and Systematized Nomenclature of Medicine Clinical Terms (SNOMED CT) codes requiring ≥2 distinct diagnosis dates. IBD overlap was identified using Crohn's disease (CD) and ulcerative colitis (UC) diagnoses. Analyses evaluated disease sequence, atopic comorbidities, medication exposure, symptom burden, and fibrostenotic complications. Among 797 patients meeting EoE criteria, 28 (3.5%) had overlapping IBD (13 CD, 17 UC), representing a 3.2-fold enrichment over the general All of Us cohort (1.1%). Overlap patients had higher rates of asthma (57.1% vs 36.8%; OR 2.29, P = 0.045) and allergic rhinitis (71.4% vs 48.5%; OR 2.65, P = 0.020). Corticosteroid exposure was substantially greater, including systemic (96.4% vs 66.1%; OR 13.8, P < 0.001) and topical corticosteroids (75.0% vs 48.1%; OR 3.23, P = 0.006). Disease sequence was bidirectional, with IBD preceding EoE in 53.6% and EoE preceding IBD in 42.9%. Despite greater treatment exposure, overlap patients demonstrated similar rates of dysphagia, food impaction, stricture, and esophageal dilation. Patients with overlapping EoE and IBD demonstrate a distinct phenotype characterized by increased atopic comorbidity without increased fibrostenotic severity. The bidirectional temporal relationship supports shared immune susceptibility rather than unidirectional disease progression.

Verrucous carcinoma of the esophagus (VCE) is a rare type of esophageal cancer with a propensity for slow local spread. Early-stage cases are often treated with endoscopic resection. VCEs that extend beyond the submucosa are usually treated with esophagectomy if resection is feasible, and definitive chemoradiotherapy is frequently reserved for cases where patient or tumor factors contraindicate resection. There have been three reported cases of a complete pathological response to neoadjuvant chemoradiotherapy for patients with VCE undergoing esophagectomy, but an approach to chemoradiotherapy for organ-preservation in operable patients has not been described. We describe a patient with an operable cT3N0M0 VCE managed with organ-preserving chemoradiation who achieved a complete clinical response, despite early discontinuation of his treatment. His clinical response was supported by serial bite-on-bite biopsies and post-treatment imaging. We review the outcomes of chemoradiotherapy for this rare disease and highlight the challenges of response assessment and surveillance that organ preservation entails.

Delayed gastric conduit emptying (DGCE) is a debilitating functional complication after esophagectomy. Because of a lack of large-scale outcome data, this project evaluated surgical revisional strategies for refractory DGCE within a recently published mechanism-informed classification system. REvisional Surgery for delayed gasTRic conduit emptying (RESTORANT) was a multicentric, retrospective cohort study including adult patients undergoing revisional surgery for DGCE from January 1, 2015, to December 31, 2024, across 26 high-volume centers that performed 11,807 esophagectomies during this period. Patients were eligible irrespective of the date of their index esophagectomy. Interventions were stratified into Class 1 (pylorus-related, C1), Class 2 (conduit-related, C2), and Class 3 (hiatus-related/paraconduit hernia, C3), with class assigned retrospectively according to the revisional procedure performed. The primary endpoint was reported symptom resolution. A total of 196 patients underwent 263 surgical interventions for DGCE. Sustained symptom relief was comparable across all classes: C1 (47.2%), C2 (58.2%), and C3 (63.9%; P = 0.165). For C1, pyloroplasty (47.6%) and Roux-en-Y diversion (46.7%) showed similar efficacy. In C2, conduit replacement (75.0%) and remodeling (61.3%) were significantly more effective than simple mobilization (50.0%; P = 0.035). For C3, paraconduit hernia repair achieved higher resolution than crural division (65.8% vs. 47.1%). The overall complication rate was 32.7%, with significantly higher major morbidity and mortality in C2 (20.0% and 3.6%) compared with C3 (13.4% and 1.7%) and C1 (16.7% and 2.8%, P = 0.047). Multivariable analysis identified no independent predictors of surgical success but was limited by heterogeneity and sample size. RESTORANT provides the first multicentric analysis of surgical DGCE repair. While symptom resolution is achievable across all classes, C2 interventions carry increased risks. These findings may help structure future prospective audits.

In gastroesophageal adenocarcinoma (GEA), recurrence following curative-intent resection represents one of the most clinically important outcomes. However, recurrence information is not consistently captured in structured fields within electronic health records (EHRs), and retrospective identification typically relies on labor-intensive manual chart review. We conducted a retrospective, single-center cohort study of patients with GEA who underwent R0 gastrectomy or esophagectomy from July 2020 to October 2024. A fully automated, rule-based natural language processing recurrence detection algorithm was developed using pathology and radiology reports extracted from the EHR. Definitive diagnostic statements in pathology reports were prioritized, while imaging-based recurrence required definitive diagnostic statements at ≥2 time points 14-120 days apart. Algorithm performance was evaluated against manual chart review, which served as the reference standard for recurrence identification. Among 414 eligible patients, 126 (30.4%) experienced recurrence, with 3-year overall survival of 80.3% and recurrence-free survival of 59.3%. The most frequent sites of recurrence were distant lymph nodes, liver, and peritoneum. The algorithm demonstrated high discrimination, with a sensitivity of 90.5%, specificity of 95.1%, positive predictive value of 89.1%, negative predictive value of 95.8%, and accuracy of 93.7%. The median absolute difference in recurrence timing was 0 days, and site classification concordance was 91.2%. This proof-of-concept study demonstrates that postoperative recurrence in GEA can be identified with reasonable reliability using an automated, interpretable algorithm based solely on pathology and radiology reports. Automated recurrence detection may substantially reduce reliance on manual chart review and facilitate scalable real-world effectiveness research and long-term outcome evaluation.

Routine esophageal biopsies during pediatric esophagogastroduodenoscopy (EGD) are recommended by current guidelines, even in the absence of macroscopic abnormalities; however, their clinical value remains uncertain. We conducted a retrospective review of all diagnostic EGDs performed at our institute between January 2019 and December 2021, a period during which esophageal biopsies were routinely obtained. Endoscopic findings and histologic results were analyzed to determine the diagnostic yield and clinical impact of biopsies in patients with a normal-appearing esophagus. A total of 1400 procedures were included, of which 1279 (91.3%) demonstrated a normal macroscopic esophagus. Among these, histological inflammation was identified in 73 cases (5.7%). However, only 27 cases (2.1%) were considered clinically significant. These included eosinophilic esophagitis in 7 patients (0.5%) and nonspecific esophagitis in 20 patients (1.6%), all of whom were treated with proton pump inhibitors. The remaining cases represented histological findings without clinical consequences during follow-up. To conclude, routine esophageal biopsies in children and adolescents with a normal-appearing esophagus during EGD appear to have a low diagnostic yield and limited impact on clinical management.