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Pseudoachalasia, also known as secondary achalasia, is a clinical condition mimicking idiopathic achalasia but most commonly caused by malignant tumors of gastroesophageal junction (GEJ). Our aim was to systematically review and present all available data on demographics, clinical features, and diagnostic modalities involved in patients with pseudoachalasia. A systematic search of literature published during the period 1978-2019 was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines (end-of-search date: June 25th, 2019). Two independent reviewers extracted data with regards of study design, interventions, participants, and outcomes. Thirty-five studies met our inclusion criteria and were selected in the present review. Overall, 140 patients with pseudoachalasia were identified, of whom 83 were males. Mean patient age was 60.13 years and the mean weight loss was 13.91 kg. A total of 33 (23.6%) patients were wrongly 'treated' at first for achalasia. The most common presenting symptoms were dysphagia, food regurgitation, and weight loss. The median time from symptoms' onset to hospital admission was 5 months. Most common etiology was gastric cancer (19%). Diagnostic modalities included manometry, barium esophagram, endoscopy, and computed tomography (CT). Pseudoachalasia is a serious medical condition that is difficult to be distinguished from primary achalasia. Clinical feature assessment along with the correct interpretation of diagnostic tests is nowadays essential steps to differentiate pseudoachalasia from idiopathic achalasia.

Background and Objectives: Encouraging data have been reported from referral centers following gastrointestinal cancer surgery. Our goal was to retrospectively review patient outcomes following gastrectomy for gastric or gastroesophageal junction (GEJ) cancer at a high-volume unit of the University of Athens. Methods: The enrollment period was from June 2003 to September 2018. Disease-free survival (DFS) and overall survival (OS) were estimated using the Kaplan-Meier method. Cox proportional hazard models were constructed to identify variables independently associated with time-to-event outcomes. Results: A total of 205 patients were analyzed. R0 resection was achieved in 183 (89.3%) patients and was more likely to occur following neoadjuvant chemotherapy (p = 0.008). Recurrence developed in 46.6% of our cohort and the median disease-free survival was 31.2 months. On multivariate analysis, only staging (HR = 2.15; 95% CI: 1.06–4.36) was independently associated with increased risk of recurrence. All-cause mortality was 57.2% and the median time of death was 40.9 months. On multivariate regression, staging (HR: 1.35; 95% CI: 1.11–1.65) and recurrence (HR: 2.87; 95% CI: 1.32–6.22) predicted inferior prognosis. Conclusions: Gastrectomy at the University of Athens has yielded favorable outcomes for patients with GEJ cancer. [ABSTRACT FROM AUTHOR]

The aim of this study is to describe outcomes of esophageal cancer surgery in a quaternary upper gastrointestinal (GI) center in Athens during the era of the Greek financial crisis. We performed a retrospective analysis of patients that underwent esophagectomy for esophageal or gastroesophageal junction (GEJ) cancer at an upper GI unit of the University of Athens, during the period January 2004–June 2019. Time-to-event analyses were performed to explore trends in survival and recurrence. A total of 146 patients were identified. Nearly half of the patients (49.3%) underwent surgery during the last 4 years of the financial crisis (2015–2018). Mean age at the time of surgery was 62.3 ± 10.3 years, and patients did not present at older ages during the recession (P  = 0.50). Most patients were stage III at the time of surgery both prior to the recession (35%) and during the financial crisis (39.8%, P  = 0.17). Ivor–Lewis was the most commonly performed procedure (67.1%) across all eras (P  = 0.06). Gastric conduit was the most common form of GI reconstruction (95.9%) following all types of surgery (P  < 0.001). Pre-recession anastomoses were usually performed using a circular stapler (65%). Both during (88.1%) and following the recession (100%), the vast majority of anastomoses were hand-sewn. R0 resection was achieved in 142 (97.9%) patients. Anastomosis technique did not affect postoperative leak (P  = 0.3) or morbidity rates (P  = 0.1). Morbidity rates were not significantly different prior to (25%), during (46.9%), and after (62.5%) the financial crisis, P  = 0.16. Utilization of neoadjuvant chemotherapy (26.9%, P  = 0.90) or radiation (8.4%, P  = 0.44) as well as adjuvant chemotherapy (54.8%, P  = 0.85) and irradiation (13.7%, P  = 0.49) was the same across all eras. Disease-free survival (DFS) and all-cause mortality rates were 41.2 and 47.3%, respectively. Median DFS and observed survival (OS) were 11.3 and 22.7 months, respectively. The financial crisis did not influence relapse (P  = 0.17) and survival rates (P  = 0.91). The establishment of capital controls also had no impact on recurrence (P  = 0.18) and survival (P  = 0.94). Austerity measures during the Greek financial crisis did not influence long-term esophageal cancer outcomes. Therefore, achieving international standards in esophagectomy may be possible in resource-limited countries when centralizing care. [ABSTRACT FROM AUTHOR]

Introduction: Gastrointestinal stromal tumors of the gastric cardia pose several technical difficulties to their resection because they are difficult to access, and they must be removed respecting oncological principles, and due to their proximity to the gastroesophageal junction, excessive removal of gastric tissue may cause deformation with gastric dysfunction, or gastroesophageal reflux. Method: Hybrid laparoscopic endoscopic partial gastrectomy is a technique that avoids these problems making use of three principles. First the tumor is pinpointed, marked, and resected under combined laparoscopic and endoscopic control to assure that it is completely resected without compromising the structure of the gastroesophageal junction. Second, a dissection of the abdominal esophagus is performed as during a Nissen fundoplication in order to increase the distance between the tumor and the gastroesophageal junction. Third the lesser curvature of the stomach is dissected, and the terminal branches of the left gastric vessels are controlled from the gastric incisura to the gastroesophageal junction exposing the lesser curvature and the posterior wall of the stomach. The tumor is resected under endoscopic control, tangentially with an endoscopic stapler applied parallel to the lesser curvature similarly to a sleeve partial gastrectomy. Results: No abdominal drain is used, and a nasogastric tube is left in place for the first 24 h after surgery. The patient receives fluid diet on the first postoperative day, is discharged on the second postoperative day, and is followed up in the outpatient department for a week. Conclusion: In this technical paper, the procedure is described in detail and demonstrated with video. [ABSTRACT FROM AUTHOR]

The article present a case study of a 62-year-old male patient presented to the emergency department with intermittent episodes of epigastric pain, postprandial fullness, occasional heartburn, and regurgitation. It mentions the clinical examination revealed diffuse epigastric tenderness without any signs of peritonitis; and the patient underwent chest radiography that showed a retrocardiac mass with an air-fluid level, compatible with a hiatal hernia.

Background Esophageal cancer patients often suffer from malnutrition. Older people constitute a group of patients more susceptible to nutritional status deterioration. The aim of this study is to investigate the differences in nutritional status between elderly patients and patients younger than 65 years of age with esophageal and gastroesophageal junction cancer. Methods The study sample consisted of 73 patients with esophageal (n = 11) and gastroesophageal junction cancer (n = 62) who were admitted for surgery in the First Department of Surgery, Laikon General Hospital, Athens, Greece, between September 2015 and December 2017. Patients were divided into 2 groups according to their age, those younger than 65 years (n = 39) and those older than 65 years (n = 34). The preoperative assessment of nutritional status was based on Patient Generated Subjective Global Assessment (PG-SGA), laboratory tests, anthropometric measurements, handgrip strength, unintentional weight loss during the last six months and Skeletal Muscle Index (SMI) derived from analysis of CT scans. Results Malnutrition and sarcopenia were more prevalent in the group of older patients compared to the group of younger ones (73.5% vs 41%, P  < 0.05 and 60% vs 35.3%, P  < 0.05). PG-SGA was significantly higher in elderly patients (12.35 vs 8.23, P  < 0.05), while SMI and handgrip strength were significantly lower in elderly patients (48.47 cm2/m2 vs 55.5 cm2/m2, P  < 0.05 and 31 kg vs 39.1 kg, P  < 0.05 respectively). Among the laboratory tests, albumin, hemoglobin and hematocrit were lower in the group of older patients (3.86 g/dL vs 4.15 g/dL, P  < 0.05, 12.25 g/dL vs 13.17 g/dL, P  < 0.05 and 36.5 vs 39.5, P  < 0.05, respectively), whereas platelet-to-lymphocyte ratio was higher (205.4 vs 156.2, P  < 0.05). Concerning anthropometric measurements, corrected mid arm muscle area and calf circumference were lower in older patients (42.15 cm2 vs 49.26 cm2, P  < 0.05 and 34.86 cm vs 36.89 cm, P  < 0.05, respectively), whereas no significant differences were observed in Body Mass Index values and unintentional weight loss between the two groups. Conclusion Geriatric patients with esophageal and gastroesophageal junction cancer have more compromised nutritional status compared to their younger counterparts. Preoperative nutritional assessment should be performed in all such patients in order to detect those who will benefit from perioperative nutritional support. Disclosure All authors have declared no conflicts of interest. [ABSTRACT FROM AUTHOR]