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Article ; Online: Paraconduit herniation - Invited editorial.

Gossage, James / Davies, Andrew

Diseases of the esophagus : official journal of the International Society for Diseases of the Esophagus

2023 Volume 36, Issue 5

Language	English
Publishing date	2023-03-11
Publishing country	United States
Document type	Journal Article
ZDB-ID	639470-x
ISSN	1442-2050 ; 1120-8694
ISSN (online)	1442-2050
ISSN	1120-8694
DOI	10.1093/dote/doad010
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Article ; Online: Minimally invasive left-sided esophagectomy (MILO): a novel approach for locally advanced tumors of the gastroesophageal junction.

Gossage, J A

Diseases of the esophagus : official journal of the International Society for Diseases of the Esophagus

2020 Volume 34, Issue 1

Abstract: Recent national audit has shown that levels of minimally invasive esophagectomy for cancer have increased to around 45% in the UK. The hybrid approach is the most common, with a laparoscopic abdominal phase and an open thoracic dissection. A number of ... ...

Abstract	Recent national audit has shown that levels of minimally invasive esophagectomy for cancer have increased to around 45% in the UK. The hybrid approach is the most common, with a laparoscopic abdominal phase and an open thoracic dissection. A number of centers have now adopted a two-phase Ivor-Lewis minimally invasive esophagectomy using a laparoscopic abdominal phase, followed by a thoracoscopic chest phase with a mini-thoracotomy to extract the specimen. The two-phase nature of the procedure lengthens the operative time and makes returning to the abdominal cavity difficult. The thoracotomy incision can also be painful and may reduce respiratory function post operatively. This report describes a novel single-phase minimally invasive left-sided technique with a mini-laparotomy for specimen extraction. This method offers excellent hiatal exposure, avoids a thoracotomy, and shortens the procedure time. Minimally invasive left-sided esophagectomy is a new useful approach for tumors located at the gastroesophageal junction.
MeSH term(s)	Esophageal Neoplasms/surgery ; Esophagectomy ; Esophagogastric Junction/surgery ; Humans ; Laparoscopy ; Operative Time ; Thoracoscopy
Language	English
Publishing date	2020-06-23
Publishing country	United States
Document type	Journal Article
ZDB-ID	639470-x
ISSN	1442-2050 ; 1120-8694
ISSN (online)	1442-2050
ISSN	1120-8694
DOI	10.1093/dote/doaa059
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Article: Long Term Survival of Heritable Pulmonary Arterial Hypertension Associated with Hereditary Hemorrhagic Telangiectasia: A Case Series.

Jamindar, Parth / Pope, Michael / Gossage, James

Journal of clinical medicine

2023 Volume 13, Issue 1

Abstract: Hereditary hemorrhagic telangiectasia (HHT) is a hereditary disease characterized by recurrent epistaxis, mucocutaneous telangiectasias, and visceral arteriovenous malformations. Multiple genetic mutations have been linked to this rare disease, including ...

Abstract	Hereditary hemorrhagic telangiectasia (HHT) is a hereditary disease characterized by recurrent epistaxis, mucocutaneous telangiectasias, and visceral arteriovenous malformations. Multiple genetic mutations have been linked to this rare disease, including ENG, ALK1 (ACVRL1), and MADH4. Pulmonary hypertension is a potential complication of HHT, with the most common phenotypes being World Health Organization (WHO) group 1 heritable pulmonary arterial hypertension (PAH), which is typically associated with ALK1 mutation; WHO group 2 pulmonary hypertension due to high output heart failure from hepatic arteriovenous malformations and/or anemia; and WHO group 2 due to high pulmonary artery wedge pressure. There is scarce evidence to help guide treatment of heritable PAH in HHT, and observational literature suggests that patients with HHT and heritable PAH have a worse prognosis compared to patients with idiopathic PAH. We describe the diagnosis, pulmonary hemodynamics, and detailed treatment courses of three patients with ALK1-associated HHT and PAH, who all exhibited objective clinical improvement with parenteral prostacyclins and oral agents.
Language	English
Publishing date	2023-12-27
Publishing country	Switzerland
Document type	Journal Article
ZDB-ID	2662592-1
ISSN	2077-0383
ISSN	2077-0383
DOI	10.3390/jcm13010141
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Article ; Online: Opinion, uptake and current practice of robot-assisted upper gastrointestinal and oesophagogastric surgery in the UK: AUGIS national survey results.

May-Miller, P / Markar, S R / Blencowe, N / Gossage, J A / Botros, A / Pucher, P H

Annals of the Royal College of Surgeons of England

2024

Abstract: Introduction: The uptake of upper gastrointestinal (GI) robotic surgery in the United Kingdom (UK), and Europe more widely, is expanding rapidly. This study aims to present a current snapshot of the practice and opinions of the upper GI community with ... ...

Abstract	Introduction: The uptake of upper gastrointestinal (GI) robotic surgery in the United Kingdom (UK), and Europe more widely, is expanding rapidly. This study aims to present a current snapshot of the practice and opinions of the upper GI community with reference to robotic surgery, with an emphasis on tertiary cancer (oesophagogastric) resection centres. Methods: An electronic survey was circulated to the UK upper GI surgical community via national mailing lists, social media and at an open-invitation conference on robotic upper GI surgery in January 2023. The survey included questions on surgeons' current practice or planned adoption (if any) of robotics at individual and unit level, and their opinions on robotic upper GI surgery in general. Priority ranking and Likert-scale response options were used. Results: In total, 81 respondents from 43 hospitals were included. Thirty-four resectional centres responded, including 30 of 31 (97%) recognised upper GI cancer centres in England. Respondents reported performing robotic surgery in 21 of 34 (61.8%) resectional centres, with a median of 65 procedures per centre performed at the time of the survey (range 0-500, interquartile range 93.75). Every centre without a robotic programme expressed a desire or had active plans to implement one. Respondents ranked surgeon ergonomics as the most important reason for pursuing robotics, followed by improvements in patient outcomes and oncological efficacy. Conclusions: Robotic upper GI practice is nascent but rapidly growing in the UK with plans for uptake in almost all tertiary centres. There is growing opinion that this is likely to become the predominant surgical approach in future with benefits to both patients and surgeons. This snapshot offers a point of reference to all stakeholders in upper GI surgery.
Language	English
Publishing date	2024-03-06
Publishing country	England
Document type	Journal Article
ZDB-ID	80044-2
ISSN	1478-7083 ; 0035-8843
ISSN (online)	1478-7083
ISSN	0035-8843
DOI	10.1308/rcsann.2024.0013
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Article ; Online: Unmet needs in survivorship: Increased anxiety post oesophago-gastric cancer surgery.

Noor, Zainab / Gossage, James / Evans, Orla / Cuffe, Ray / On Behalf Of The Guy's St Thomas' Oesophago-Gastric Research Group

European journal of surgical oncology : the journal of the European Society of Surgical Oncology and the British Association of Surgical Oncology

2024 Volume 50, Issue 6, Page(s) 108046

Abstract: Introduction: Despite significant surgical advancements in the treatment of oesophago-gastric cancer (OGC), patients often experience a considerable decline in health-related quality of life postoperatively. Psychological factors, such as hypervigilance ...

Abstract	Introduction: Despite significant surgical advancements in the treatment of oesophago-gastric cancer (OGC), patients often experience a considerable decline in health-related quality of life postoperatively. Psychological factors, such as hypervigilance and symptom-specific anxiety, may contribute to this. This study aimed to investigate the prevalence and trend of hypervigilance and symptom-specific anxiety in OGC survivors across treatment stages. Materials and methods: 103 patients with either gastric or oesophageal cancer, treated with surgery (and/or neoadjuvant chemotherapy), completed a specialist measure of oesophageal hypersensitivity (Oesophageal Anxiety and Hypervigilance Scale) at five time-points: spanning from diagnostic clinics to 6 months post-hospital discharge. Results: The results indicate a trend of rising symptom-specific anxiety and hypervigilance scores over time post-hospital discharge. Total scores showed variations over time; elevated at diagnosis, decreasing between pre-operative assessment and 2-4 weeks post-hospital discharge, and rising again at between 3 and 6 months post-discharge, exceeding the average score at diagnosis. The patterns for the subscale scores for symptom-specific anxiety and hypervigilance followed a similar trend, though anxiety scores consistently exceeded hypervigilance scores at previous time-points. Conclusion: In noting the presence and variations of symptom-specific anxiety and hypervigilance in patients with OGC, this study directs attention to the previously unexplored significant psychological distress. Although specific conclusions from the data are restricted due to the study's design, it indicates the importance of assessing and addressing these psychological factors for effective management of patients with OGC.
Language	English
Publishing date	2024-02-22
Publishing country	England
Document type	Journal Article
ZDB-ID	632519-1
ISSN	1532-2157 ; 0748-7983
ISSN (online)	1532-2157
ISSN	0748-7983
DOI	10.1016/j.ejso.2024.108046
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Zs.A 1149: Show issues			Location: Je nach Verfügbarkeit (siehe Angabe bei Bestand) bis Jg. 1994: Bestellungen von Artikeln über das Online-Bestellformular Jg. 1995 - 2021: Lesesall (1.OG) ab Jg. 2022: Lesesaal (EG)
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Article ; Online: Multiple staging investigations may not change management in patients with high-grade dysplasia or early esophageal adenocarcinoma.

Reyhani, A / Gimson, E / Baker, C / Kelly, M / Maisey, N / Meenan, J / Subesinghe, M / Hill, M / Lagergren, J / Gossage, J / Zeki, S / Dunn, J / Davies, A

Diseases of the esophagus : official journal of the International Society for Diseases of the Esophagus

2023 Volume 36, Issue 10

Abstract: The clinical value of multiple staging investigations for high-grade dysplasia or early adenocarcinoma of the esophagus is unclear. A single-center prospective cohort of patients treated for early esophageal cancer between 2000 and 2019 was analyzed. ... ...

Abstract	The clinical value of multiple staging investigations for high-grade dysplasia or early adenocarcinoma of the esophagus is unclear. A single-center prospective cohort of patients treated for early esophageal cancer between 2000 and 2019 was analyzed. This coincided with a transition period from esophagectomy to endoscopic mucosal resection (EMR) as the treatment of choice. Patients were staged with computed tomography (CT), endoscopic ultrasound (EUS) and 2-deoxy-2-[18F]fluoro-d-glucose (FDG) positron emission tomography(PET)/CT. The aim of this study was to assess their accuracy and impact on clinical management. 297 patients with high-grade dysplasia or early adenocarcinoma were included (endoscopic therapy/EMR n = 184; esophagectomy n = 113 [of which a 'combined' group had surgery preceded by endoscopic therapy n = 23]). Staging accuracy was low (accurate staging EMR: CT 40.1%, EUS 29.6%, FDG-PET/CT 11.0%; Esophagectomy: CT 43.3%, EUS 59.7%, FDG-PET/CT 29.6%; Combined: CT 28.6%, EUS46.2%, FDG-PET/CT 30.0%). Staging inaccuracies across all groups that could have changed management by missing T2 disease were CT 12%, EUS 12% and FDG-PET/CT 1.6%. The sensitivity of all techniques for detecting nodal disease was low (CT 12.5%, EUS 12.5%, FDG-PET/CT0.0%). Overall, FDG-PET/CT and EUS changed decision-making in only 3.2% of patients with an early cancer on CT and low-risk histology. The accuracy of staging with EUS, CT and FDG-PET/CT in patients with high-grade dysplasia or early adenocarcinoma of the esophagus is low. EUS and FDG-PET/CT added relevant staging information over standard CT in very few cases, and therefore, these investigations should be used selectively. Factors predicting the need for esophagectomy are predominantly obtained from EMR histology rather than staging investigations.
MeSH term(s)	Humans ; Prospective Studies ; Fluorodeoxyglucose F18 ; Positron Emission Tomography Computed Tomography ; Esophageal Neoplasms/diagnostic imaging ; Esophageal Neoplasms/surgery ; Esophageal Neoplasms/pathology ; Adenocarcinoma/diagnostic imaging ; Adenocarcinoma/surgery ; Endosonography/methods ; Positron-Emission Tomography ; Neoplasm Staging
Chemical Substances	Fluorodeoxyglucose F18 (0Z5B2CJX4D)
Language	English
Publishing date	2023-04-10
Publishing country	United States
Document type	Journal Article
ZDB-ID	639470-x
ISSN	1442-2050 ; 1120-8694
ISSN (online)	1442-2050
ISSN	1120-8694
DOI	10.1093/dote/doad020
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Article ; Online: Schizencephaly in Hereditary Hemorrhagic Telangiectasia.

Gaines, J J / Gilbert, B C / Gossage, J R / Parker, W / Reddy, A / Forseen, S E

AJNR. American journal of neuroradiology

2022 Volume 43, Issue 11, Page(s) 1603–1607

Abstract: Background and purpose: The presence of malformations of cortical development in patients with hereditary hemorrhagic telangiectasia has been reported on previous occasions. We evaluated a sample of adults with hereditary hemorrhagic telangiectasia for ... ...

Abstract	Background and purpose: The presence of malformations of cortical development in patients with hereditary hemorrhagic telangiectasia has been reported on previous occasions. We evaluated a sample of adults with hereditary hemorrhagic telangiectasia for the presence of malformations of cortical development, spatial coincidence of malformations of cortical development and AVMs, and the coincidence of brain and pulmonary AVMs. Materials and methods: A total of 141 patients 18 years of age or older who were referred to the Augusta University hereditary hemorrhagic telangiectasia clinic and underwent brain MR imaging between January 19, 2018, and December 3, 2020, were identified. MR imaging examinations were reviewed retrospectively by 2 experienced neuroradiologists, and the presence of malformations of cortical development and AVMs was confirmed by consensus. Demographic and clinical information was collected for each case, including age, sex, hereditary hemorrhagic telangiectasia status by the Curacao Criteria, mutation type, presence of malformations of cortical development, presence of brain AVMs, presence of pulmonary AVMs, and a history of seizures or learning disabilities. Results: Five of 141 (3.5%) patients with hereditary hemorrhagic telangiectasia had malformations of cortical development. Two of the 5 patients with polymicrogyria also had closed-lip schizencephaly. One of the patients had a porencephalic cavity partially lined with heterotopic GM. The incidence of spatially coincident polymicrogyria and brain AVMs was 40% (2/5 cases). Of the patients with hereditary hemorrhagic telangiectasia and malformations of cortical development, 4/5 (80%) had pulmonary AVMs and 2/5 (40%) had brain AVMs. Conclusions: To our knowledge, we are the first group to report the presence of schizencephaly in patients with hereditary hemorrhagic telangiectasia. The presence of schizencephaly and porencephaly lends support to the hypothesis of regional in utero cerebral hypoxic events as the etiology of malformations of cortical development in hereditary hemorrhagic telangiectasia.
MeSH term(s)	Adult ; Humans ; Adolescent ; Telangiectasia, Hereditary Hemorrhagic/complications ; Telangiectasia, Hereditary Hemorrhagic/diagnostic imaging ; Telangiectasia, Hereditary Hemorrhagic/epidemiology ; Schizencephaly ; Polymicrogyria ; Retrospective Studies ; Arteriovenous Malformations
Language	English
Publishing date	2022-10-20
Publishing country	United States
Document type	Journal Article
ZDB-ID	603808-6
ISSN	1936-959X ; 0195-6108
ISSN (online)	1936-959X
ISSN	0195-6108
DOI	10.3174/ajnr.A7677
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Article ; Online: SX-ELLA biodegradable stent for benign oesophageal strictures: a systematic review and proportion meta-analysis.

Kailla, Elisha / Rezai, Fatema / Kansci, Ange Kamille / Akande, Oluwadamilola / Gossage, James

Surgical endoscopy

2022 Volume 37, Issue 4, Page(s) 2476–2484

Abstract: Background: This systematic review aimed to analyse the use of the SX-ELLA biodegradable stent (BDS) for benign oesophageal strictures through the assessment of clinical and technical success, differences in pre- and post-BDS insertion dysphagia scores, ...

Abstract	Background: This systematic review aimed to analyse the use of the SX-ELLA biodegradable stent (BDS) for benign oesophageal strictures through the assessment of clinical and technical success, differences in pre- and post-BDS insertion dysphagia scores, rates of stent migration, and safety. Methods: A systematic review was reported according to PRISMA guidelines, with a prospectively registered protocol. The databases PubMed, Embase, SCOPUS, and ClinicalTrials.gov were searched up to March 2022. Studies assessing the use of the SX-ELLA BDS in adults with benign oesophageal strictures were included. A pooled data analysis was conducted to analyse the clinical and technical success associated with BDS use, rate of stent migration, and safety. Results: Of the 1509 articles identified, 16 studies treating 246 patients were eligible for inclusion. BDS was clinically successful in 41.9% of cases (95% CI = 35.7 - 48.1%), defined as those who experienced complete symptom resolution following BDS insertion. Technical success was achieved in 97.2% of patients (95% CI = 95.1 - 99.3%). A pooled analysis concluded a decrease in mean dysphagia score of 1.8 points (95% CI = 1.68 - 1.91) following BDS insertion. Re-intervention was required in 89 patients (36.2%, 95% CI = 30.2 - 42.2%), whilst stent migration occurred in 6.5% of patients (95% CI = 3.4 - 9.6%). A total of 37 major clinical complications related to BDS insertion were reported (15.0%, 95% CI = 10.5 - 19.5%). Conclusion: The pooled data analysis demonstrates the high technical and moderate clinical success of the SX-ELLA biodegradable stent, supporting its use for benign oesophageal strictures in adults. However, greater evidence is required for more robust conclusions to be made in terms of success when compared to alternative methods of intervention, such as endoscopic dilation.
MeSH term(s)	Adult ; Humans ; Constriction, Pathologic ; Data Analysis ; Deglutition Disorders/etiology ; Deglutition Disorders/surgery ; Esophageal Stenosis/etiology ; Esophageal Stenosis/surgery ; Stents/adverse effects
Language	English
Publishing date	2022-12-08
Publishing country	Germany
Document type	Journal Article ; Meta-Analysis ; Systematic Review
ZDB-ID	639039-0
ISSN	1432-2218 ; 0930-2794
ISSN (online)	1432-2218
ISSN	0930-2794
DOI	10.1007/s00464-022-09767-w
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Article ; Online: Association of Upper GI Surgery of Great Britain and Ireland (AUGIS) Delphi consensus recommendations on the adoption of robotic upper GI surgery.

Pucher, P H / Maynard, N / Body, S / Bowling, K / Chaudry, M Asif / Forshaw, M / Hornby, S / Markar, S R / Mercer, S J / Preston, S R / Sgromo, B / van Boxel, G I / Gossage, J A

Annals of the Royal College of Surgeons of England

2024

Abstract: Background: The adoption of robotic platforms in upper gastrointestinal (GI) surgery is expanding rapidly. The absence of centralised guidance and governance in adoption of new surgical technologies may lead to an increased risk of patient harm.: ... ...

Abstract	Background: The adoption of robotic platforms in upper gastrointestinal (GI) surgery is expanding rapidly. The absence of centralised guidance and governance in adoption of new surgical technologies may lead to an increased risk of patient harm. Methods: Surgeon stakeholders participated in a Delphi consensus process following a national open-invitation in-person meeting on the adoption of robotic upper GI surgery. Consensus agreement was deemed met if >80% agreement was achieved. Results: Following two rounds of Delphi voting, 25 statements were agreed on covering the training process, governance and good practice for surgeons' adoption in upper GI surgery. One statement failed to achieve consensus. Conclusions: These recommendations are intended to support surgeons, patients and health systems in the adoption of robotics in upper GI surgery.
Language	English
Publishing date	2024-03-06
Publishing country	England
Document type	Journal Article
ZDB-ID	80044-2
ISSN	1478-7083 ; 0035-8843
ISSN (online)	1478-7083
ISSN	0035-8843
DOI	10.1308/rcsann.2024.0014
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Article ; Online: Multicentre validation of CT grey-level co-occurrence matrix features for overall survival in primary oesophageal adenocarcinoma.

O'Shea, Robert / Withey, Samuel J / Owczarczyk, Kasia / Rookyard, Christopher / Gossage, James / Godfrey, Edmund / Jobling, Craig / Parsons, Simon L / Skipworth, Richard J E / Goh, Vicky

European radiology

2024

Abstract: Background: Personalising management of primary oesophageal adenocarcinoma requires better risk stratification. Lack of independent validation of proposed imaging biomarkers has hampered clinical translation. We aimed to prospectively validate ... ...

Abstract	Background: Personalising management of primary oesophageal adenocarcinoma requires better risk stratification. Lack of independent validation of proposed imaging biomarkers has hampered clinical translation. We aimed to prospectively validate previously identified prognostic grey-level co-occurrence matrix (GLCM) CT features for 3-year overall survival. Methods: Following ethical approval, clinical and contrast-enhanced CT data were acquired from participants from five institutions. Data from three institutions were used for training and two for testing. Survival classifiers were modelled on prespecified variables ('Clinical' model: age, clinical T-stage, clinical N-stage; 'ClinVol' model: clinical features + CT tumour volume; 'ClinRad' model: ClinVol features + GLCM_Correlation and GLCM_Contrast). To reflect current clinical practice, baseline stage was also modelled as a univariate predictor ('Stage'). Discrimination was assessed by area under the receiver operating curve (AUC) analysis; calibration by Brier scores; and clinical relevance by thresholding risk scores to achieve 90% sensitivity for 3-year mortality. Results: A total of 162 participants were included (144 male; median 67 years [IQR 59, 72]; training, 95 participants; testing, 67 participants). Median survival was 998 days [IQR 486, 1594]. The ClinRad model yielded the greatest test discrimination (AUC, 0.68 [95% CI 0.54, 0.81]) that outperformed Stage (ΔAUC, 0.12 [95% CI 0.01, 0.23]; p = .04). The Clinical and ClinVol models yielded comparable test discrimination (AUC, 0.66 [95% CI 0.51, 0.80] vs. 0.65 [95% CI 0.50, 0.79]; p > .05). Test sensitivity of 90% was achieved by ClinRad and Stage models only. Conclusions: Compared to Stage, multivariable models of prespecified clinical and radiomic variables yielded improved prediction of 3-year overall survival. Clinical relevance statement: Previously identified radiomic features are prognostic but may not substantially improve risk stratification on their own. Key points: • Better risk stratification is needed in primary oesophageal cancer to personalise management. • Previously identified CT features-GLCM_Correlation and GLCM_Contrast-contain incremental prognostic information to age and clinical stage. • Compared to staging, multivariable clinicoradiomic models improve discrimination of 3-year overall survival.
Language	English
Publishing date	2024-03-25
Publishing country	Germany
Document type	Journal Article
ZDB-ID	1085366-2
ISSN	1432-1084 ; 0938-7994 ; 1613-3749
ISSN (online)	1432-1084
ISSN	0938-7994 ; 1613-3749
DOI	10.1007/s00330-024-10666-y
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