Exploring the Landscape of Esophageal Discontinuity Procedures and Cervical Esophagostomy in the Modern Era: A Scoping Review
Bibliographic record
Abstract
Background: Esophageal discontinuity remains a significant challenge. However, the literature lacks a comprehensive understanding of the indications for esophageal discontinuity, strategies for reversal, and long-term outcomes. This scoping review characterizes the existing evidence, identifies knowledge gaps and provides practical considerations. Methods: Following Arksey and O’Malley frameworks, we searched MEDLINE, EMBASE, and CENTRAL for studies from 1990 to 2023 involving patients who received a cervical esophagostomy for gastrointestinal discontinuity. Grey literature, editorials, protocols, and non-English studies were excluded. Two authors independently screened titles, abstracts, and full texts. Results: Of the 231 studies included, 150 (65%) were case reports, 62 (26.5%) were single-institutional observational studies, 10 (4.3%) were reviews, with few other study designs. Most studies (68%) were in the adult population. The most common geographical region was East Asia (32%), followed by North America and Western Europe (both 24.2%). The most common indications were perforation (29%), stricture/fistula (21.6%) and atresia (18.6%), with notable regional variation. Only 24.2% of studies occurred in the oncologic setting and 24.2% of studies did not report whether reversal was considered. Among 1884 patients with esophageal discontinuity, the overall reversal rate was 79.8%; excluding atresia cases, the rate was 73.2%. Conclusion: There are critical gaps in the literature, including a lack of multi-institutional studies, limited descriptions of reversal procedures, lack of measurement of nutritional and functional outcomes and few clinical trials. Greater international collaboration is needed to develop a longitudinal registry and define long-term quality outcomes for this complex rare disease entity which could be known as foregut failure .
Fetched live from OpenAlex and de-inverted. Abstracts are not stored in this database: the inverted indexes are 8.6 GB of the frame’s 9.3 GB of text, and the host has 13 GB free.
How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.015 | 0.062 |
| Meta-epidemiology (narrow) | 0.001 | 0.001 |
| Meta-epidemiology (broad) | 0.004 | 0.004 |
| Bibliometrics | 0.022 | 0.021 |
| Science and technology studies | 0.001 | 0.002 |
| Scholarly communication | 0.005 | 0.006 |
| Open science | 0.002 | 0.003 |
| Research integrity | 0.003 | 0.002 |
| Insufficient payload (model declined to judge) | 0.003 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".