Foregut Journal

🚨 Early Feeding After Esophagectomy 📄 Study by Adam R. Dyas et al. • 🍽️ POD1–2 feeding • ❌ No leaks / no aspiration • 🏥 LOS ~5 days • 🔁 5% readmission • ⚠️ 1 conduit complication (2.5%) journals.sagepub.com/doi/abs/10.117…

🔬 Fair agreement among experts using AFS EGJ classification 📉 Highlights limits of current grading systems 🚀 Supports need for refinement, training, and standardization journals.sagepub.com/doi/full/10.11… @WasseemSkefMD @FaresAyoubMD @shifaumarMD @TheresaNguyenMD @ScottALarsonMD @BCMCME

🧠📊 Esophageal manometry interpretation remains challenging even for experts 🔹 93% encounter difficult studies 🔹 Achalasia & IEM most challenging 🔹 🧪 Barium esophagram often helps 🔹 Experience alone does not solve it 🔗 doi.org/10.1177/263451… @Jalil_Ala @RonnieFass

@UCIrvineHealth @drdevirgilio @DocGrigorian @UCIrvineSurgery @UCIrvineCCR @USCGenSurg @ForegutSociety 🔗 Open access: journals.sagepub.com/doi/epub/10.11…

🩺 Primary DGE after distal pancreatectomy is uncommon (3.6% when pancreatic fistula excluded) 🔓 Open approach & 🩸 vascular resection = strongest predictors ⏱️ DGE → longer LOS & ↑ readmission 👉 Useful for preop counseling & risk stratification @UCIrvineHealth

Check out this popular AFS Journal article from 2025: "From Endoscopic Recognition to Public Health Reform: Chevalier Jackson and Peptic and Caustic Esophageal Injury" by Sven E. Eriksson, Brian M. Johnson, Sricharan Chalikonda, & Shahin Ayazi. Read here: zurl.co/GjLZs

🔍 Difficult-to-manage peptic esophageal strictures Most respond to PPIs and dilation, but when they don’t, surgery matters. Authors outlines a stepwise, physiology-driven approach to escalation and operative decision-making. journals.sagepub.com/doi/10.1177/26… @AngelDonoMD @SurgeryUTHSC

• New in Foregut: TULIPS Class 2.0 • Defines standardized use of intraoperative EndoFLIP in foregut surgery • Emphasizes real-time functional assessment to guide surgical decisions • Bridges physiology with operative technique 🔗 journals.sagepub.com/doi/10.1177/26… #Foregut #EndoFLIP

🚨 New Publication 🚨 📚 Interobserver Agreement of the American Foregut Society Esophagogastric Junction Classification: A Prospective Observational Study ✅ AFS EGJ classification demonstrated fair interobserver agreement between endoscopists for patients referred for endoscopy for evaluation of GERD which has implications for widespread implementation. Read here ⤵️ journals.sagepub.com/doi/10.1177/26… @WasseemSkefMD @FaresAyoubMD @shifaumarMD @TheresaNguyenMD @ScottALarsonMD @BCMCME @bcm_gihep @tmcddc @BCMDeptMedicine @foregut_journal #medtwitter #MedEd #GITwitter #AFS

• 🔧 When dilation fails: Surgical options include segmental resection or esophageal replacement (gastric/colon/jejunal). • 🧒 Goal of care: Preserve native esophagus whenever possible.

🔍 New in Foregut Journal Pediatric Caustic Esophageal Strictures: Key Takeaways • 🧪 Most common cause: Caustic ingestion remains the leading driver of pediatric esophageal strictures. journals.sagepub.com/doi/abs/10.117…

• 🩻 Diagnosis: Endoscopy and barium swallow are central to grading severity and defining anatomy. • 🎈 First-line therapy: Serial balloon (or bougie) dilations are highly effective for most children.

⚖️ No age-based differences in outcomes 📉 Consistent symptom relief 🩺 Even with larger hiatal hernias, ≥65 patients performed equally well ➡️ MSA is an effective option for appropriately selected GERD patients ≥65.

📰 In the December issue of Foregut Is Magnetic Sphincter Augmentation as Effective in Patients ≥65? journals.sagepub.com/doi/abs/10.117… @BrowardHealth

A 98-patient cohort study shows yes — older adults experience comparable improvements in regurgitation, HRQL, dissatisfaction, and PPI use as younger patients at 3–6 months and ≥1 year.

🚀 New in FOREGUT: Future Opportunities for P-CABs in GERD & Beyond 🔗 Read the full article in Foregut: journals.sagepub.com/doi/abs/10.117… 🔍 Highlights: • 🔬 Faster, stronger, longer: P-CABs deliver rapid-onset and sustained acid suppression • 🌙 Nighttime relief: Promising control of nocturnal GERD where PPIs often fall short • 🧪 A better diagnostic tool? Early evidence supports a potential “P-CAB test” • 🔁 Refractory GERD: Effective option when PPIs fail • 🫁 Beyond the esophagus: Early signals in extra-esophageal symptoms • 🔥 Functional dyspepsia: Higher response rates reported vs traditional therapy • 🩺 Post-POEM & post-sleeve GERD: Emerging therapeutic role • 🧬 Possible future role in Barrett’s esophagus and EoE—requiring further study @RonnieFass @MetroHealthMed @metrohealthCLE @CWRU_GI 📈 Takeaway: P-CABs may reshape the therapeutic landscape of GERD and acid-related disorders, offering meaningful advantages over current standard therapy.

🚨 New in #ForegutJournal 🩺 Endoscopic Approach to the Difficult-to-Manage Peptic Esophageal Stricture 🔗 journals.sagepub.com/doi/abs/10.117… @WeillCornell @WCMDeptofMed @DrCriccoLizza @WCM_GI @FeliceSchnoll @katzpo 🔹 Refractory peptic strictures need precision + planning 🔹 Adjuncts like 💉 triamcinolone or mitomycin C reduce recurrence 🔹 💊 PCABs may outperform PPIs for acid control 🔹 ✂️ Incisional therapy & temporary stents for complex cases 🔹 🤝 Self-dilation empowers patients, limits repeat scopes 📈 A patient-centered, stepwise approach = durable relief in even the toughest strictures. #Endoscopy #GERD #Esophagus #GI

🚨 In Foregut 🚨 Is there a role for salvage TIF after surgical hiatal repair? 🤔 📄 Arham et al. evaluated outcomes of Transoral Incisionless Fundoplication (TIF) in patients with persistent or recurrent reflux following prior hiatal or paraesophageal hernia repair. 👥 14 post-surgical patients 📈 50% achieved symptomatic relief 😊 71% reported satisfaction 🛡️ 0 complications ⏱️ Mean follow-up: 12 months 💡 Takeaway: Salvage TIF may provide a safe, minimally invasive option for carefully selected post-surgical reflux patients. 🔗 journals.sagepub.com/doi/10.1177/26… @VMFHealth

✨ New in Foregut ✨ 2025 AFS Presidential Address – “Daring to Dream” by Dr. Dan Lister (@StopMyReflux ) 💭 A reflection on how belief, collaboration, and courage shaped the #Foregut movement. 🔹 Key Highlights: • 🌎 From 5 dreamers to a global Foregut community • 🤝 Collaboration > confrontation — the “UNSociety” model • 👩‍⚕️ Empowering the next generation through mentorship • 💡 Innovation through partnership with industry • 💬 “Dream big, work hard, and be excellent at what you do.” journals.sagepub.com/doi/10.1177/26… @ForegutSociety #AFS2025 #Foregut #Leadership #Surgery #Inspiration