Introduction: A clinicopathological study of diagnosis and treatment for esophageal cancer in Hiraka General Hospital was performed.Patients and Methods: We retrospectively analyzed clinical records of 417 esophageal cancer patients treated between January 1998 through December 2009.Results: It was presumed that we took care of about 10% of esophageal cancer patients in Akita prefecture. Sixty-six percent of the patients were referred to our hospital from other medical facilities during the period under review. On the other hand, those patients with esophageal cancer detected by medical examination or health screening accounted for only 9.6%. The rate of those patients who could receive definitive therapies was 75% (313 cases), and 308 cases (98%) underwent curative surgical resection in Hiraka General Hospital. Among the patients who had received therapy aimed for complete cure, 285 patient (91.1%), went through treatment as planned, and the complete response rate was 73%. Five-year survival rates of all the patients in stage 0, stage I, stage II, stage III and stage IV were 44.7%, 76.3%, 67.3%, 38.0%, 31.6% and 15.6%, respectively. These survival rates are never be inferior to those of major centers for esophageal cancer in Japan. Long term survival rates of the patients who had been diagnosed with esophageal cancer by medical examination or health screening were statistically significantly better than those of the patients who were diagonosed by another categories. Among the 209 patients who responded completely to definitive therapy, the cancer recurred in 50 patients (23.9%). Among the 50 recurrent group, recurrence has been primarily recognized in 33 patients (67%) with in 12 months after definitive therapy and in 40 patients (82%) within 24 months. Therefore, a close follow-up is very important up to 24 months after treatment. As for the cause of death in patients who underwent curative resection the death from esophageal cancer accounted for 66% whereas the death from other diseasea and/or other type of cancer accounted for 34%.

We encountered a case of hypercobalaminemia induced by oral intake of an energy drink after total gastrectomy. The patient was referred to our hospital due to findings suspicious for gastric cancer on screening. A 20 mm type 0-IIc lesion was detected in the gastric subcardia on esophagogastroduodenoscopy. Total gastrectomy followed by Roux-en-Y reconstruction was performed. He was discharged without complications. His basal serum vitamin B₁₂ level was initially maintained with monthly intramuscular injections of vitamin B₁₂. After 9 months, his serum vitamin B₁₂ level suddenly increased up to 36-fold higher than the normal range and persisted there for one year without vitamin B₁₂ injections. The patient ultimately reported consuming half a bottle of an energy drink each day during this time period. This case demonstrates the risk of unexpected hypervitaminemia resulting from self-administration of nutritional supplements.

BACKGROUND/AIMS: Self-expandable metallic stent (SEMS) placement is effective for dysphagia that results from malignant obstruction of the esophagus or gastric cardia; however, stent-related complications may be life-threatening. Thus, the goal of this study was to identify risk factors associated with complications following esophageal stenting. METHODS: Of the 71 patients who underwent SEMS placement for dysphagia as a result of malignant stricture of the esophagus or gastric cardia, 53 patients with squamous cell carcinoma or adenocarcinoma, without previous SEMS placement, without a fistula, and without recurrent tumor after surgery were retrospectively identified. The occurrence of stent-related complications was used as an endpoint. RESULTS: Stent-related complications were identified in 26 patients (49.1%), and major complications occurred in 14 patients (26.4%). The use of an Ultraflex stent (odds ratio [OR], 6.81; 95% confidence interval [CI], 1.54 to 30.00; p=0.011) and prior chemotherapy (OR, 6.13; 95% CI, 1.46 to 25.70; p=0.013) were significantly associated with stent-related complications. Moreover, the use of an Ultraflex stent (OR, 19.60; 95% CI, 2.26 to 170.00; p=0.007) and prior radiation (OR, 25.70; 95% CI, 2.37 to 280.00; p=0.008) significantly increased the risk of major complications. CONCLUSIONS: The use of an Ultraflex stent and prior radiation and/or chemotherapy may represent risk factors for complications following esophageal SEMS placement.
Adenocarcinoma ; Carcinoma, Squamous Cell ; Cardia* ; Constriction, Pathologic ; Deglutition Disorders ; Drug Therapy ; Esophagus* ; Fistula ; Humans ; Retrospective Studies ; Risk Factors ; Stents