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Background We recently selected double-pedicled free jejunal transfer for reconstruction of pharyngolaryngoesophagectomy to reduce the vascular thrombosis-induced necrosis in free jejunal transfer. We herein report our experience with this procedure. Methods Single-pedicled free jejunal transfer for reconstruction of pharyngolaryngoesophagectomy was performed from January 2006 to November 2013, and double-pedicled free jejunal transfer (i.e. two pairs of jejunal arteriovenous anastomoses) was performed from December 2013 to December 2016 in Kansai Medical University Hospital. We compared the perioperative outcomes and complications between these two procedures. Results Sixty-two patients (58 men, 4 women; median age, 66 years; age range, 51–83 years) underwent single-pedicled free jejunal transfer. Twenty-eight patients (25 men, 3 women; median age, 70 years; age range, 47–84 years) underwent double-pedicled free jejunal transfer. Twenty-eight patients received preoperative treatments. Table 1 shows the perioperative outcomes and complications. Conclusion No thrombus of the free jejunum occurred, no anastomotic leakage occurred, and all flaps survived in the double-pedicled free jejunal transfer group. We believe that double-pedicled free jejunal transfer for reconstruction of pharyngolaryngoesophagectomy is a reliable and useful procedure. Disclosure All authors have declared no conflicts of interest.

Background Chylothorax after thoracic surgery is initially managed conservatively, but when persistent high-output chylothorax (> 1000 mL/day) is managed conservatively, the mortality rate exceeds 50%. The objective of this study was to examine the clinical results of thoracic duct embolization (TDE) in cases of chylothorax after esophagectomy for esophageal cancer. Methods The data of 9 patients (7 men, 2 women) whounderwent TDE for persistent high-output chylothorax after esophagectomy for esophageal cancer were gathered retrospectively. Lymphangiography was used to identify the supply route of lymphatic fluid from the lumbar lymphatics to the leakage site and lipiodol extravasation and its site. Transcatheter thoracic ductography was used to identify communication between the thoracic duct and the leakage site and extravasation of the iodinated contrast agent. TDE was performed by percutaneous transabdominal approach to cut off the supply route. The technical success and clinical success (drainage volume ≥ 10mL/kg/day within 7 days after TDE) of TDE were evaluated. Results The technical and clinical success rates of TDE were 89.9%, with no serious complications observed. In 44% of patients, the thoracic duct had ruptured. In the other 56%, the ruptured was in a collateral route bypassing the thoracic duct; the leaking lymphatic fluid was supplied without passing through the thoracic duct in 50% of these patients, but clinical success was achieved even in such patients. Conclusion TDE was found to be a safe method of treatment, with no serious complications. Disclosure All authors have declared no conflicts of interest.

Background IgG4-related disease (IgG4-RD) is a systemic disease characterized by fibrosing inflammation with an abundance of IgG4-positive plasma cells. IgG4-RD has been found to affect various organs. Many cases of IgG4-RD affecting the extrapancreatic organs have been reported in patients without pancreatic lesions. Methods Sclerosing esophagitis with IgG4-positive plasma cell infiltration is very rare disease. We report a case of esophageal benign stricture that was difficult to diagonose. Results A 76-year-old woman had been experiencing slight difficulty in swallowing in the 3 years prior to this presentation. Her dysphagia had progressed and she began to vomit frequently after meals and lost weight while hospitalized after surgery for cervical cancer. Esophagogastroduodenoscopy and an esophagram showed circumferential erosion and a stricture of the thoracic esophagus. No malignant cells were identified. However, because it was difficult to exclude a malignant tumor, she underwent esophageal resection. The resected specimen showed stricture with mucosal erosion and transmural wall hypertrophy. On histological examination, transmural hyperplasia consisting of inflammatory granulation tissue with abundant infiltration of IgG4-positive plasma cells and lymphocytes was observed. Conclusion A probable diagnosis of IgG4-related disease was made because comprehensive diagnostic criteria for this condition were met. IgG4-related esophageal disease presenting as esophageal lesions alone is very rare. Disclosure All authors have declared no conflicts of interest.