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Early esophageal neoplasia: etiology, pathophysiology, pathogenesis and treatment. Barrett's esophagus and early esophageal adenocarcinoma
Krajčíová, Jana ; Martínek, Jan (advisor) ; Dolina, Jiří (referee) ; Bureš, Jan (referee)
Background: Barrett's esophagus (BE) is a premalignant condition defined by replacement of normal esophageal squamous-cell epithelium by cylindrical epithelium with intestinal metaplasia (IM). Patients with BE associated neoplasia (BORN) are candidates for endoscopic treatment. The aims of our studies were: (1) analysis of long-term efficacy of radiofrequency ablation (RFA) and evaluation of risk factors for persistent/ recurrent neoplasia/ IM; (2) to assess the results and safety of confocal laser endomicroscopy (CLE) compared to standard biopsies in patients after successful endoscopic treatment of BORN; (3) to assess the sampling quality obtained by different types of forceps; and (4) to assess "de novo" reflux after peroral endoscopic myotomy (POEM) and its severity (the risk of development of further complications). Patients and methods: We performed a total of 4 studies. (1) In a retrospective RFA study we evaluated data of 136 patients treated endoscopically for BORN in 4 centers in the Czech Republic. (2) In a prospective, pathologist-blinded, CLE study, we evaluated concordance in the detection of IM or neoplasia with CLE compared to standard biopsies in 56 patients who underwent standard surveillance endoscopy. (3) In a prospective study comparing 4 types of forceps, we evaluated the...
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Esophageal achalasia - etiology, pathophysiology and treatment.
Vacková, Zuzana ; Martínek, Jan (advisor) ; Balihar, Karel (referee) ; Rejchrt, Stanislav (referee)
Background: Achalasia is a primary esophageal motility disorder that can be classified into three types (I-III) based on high-resolution manometry (HRM). Exact pathogenesis is unknown, but immune-mediated processes and genetic predisposition play a role, which is supported by finding of a genetic risk variant (rs28688207 insertion) in HLA-DQB1 gene that is strongly associated with achalasia. Per-oral endoscopic myotomy (POEM) has become a standard treatment for achalasia, but the long-term efficacy, safety and impact on esophageal physiology are not fully understood. The aims of our studies were to perform the first genotype-phenotype analysis investigating the frequency of rs28688207 accross three HRM types of achalasia, to evaluate the efficacy and safety of POEM and to assess the post-POEM esophageal motility patterns. Patients and methods: These were three retrospective studies of prospectively collected data. Genotyping of the rs2868827 insertion was performed using real-time PCR in 347 patients from Czech Republic (n = 163), Germany (n = 114), Greece (n = 70). The efficacy and safety of POEM were evaluated in 133 patients treated in our center. The post-POEM esophageal motility was assessed using the Chicago Classification in 237 patients in whom HRM was performed prior to and after POEM....
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