Sebastian S Zeki

Sebastian S Zeki
Guy's and St Thomas' NHS Foundation Trust · Department of Gastroenterology

MA MSc MBBS MRCP

About

93
Publications
6,249
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929
Citations
Introduction
Interests include: Pathology of the gastrointestinal tract, Barrett's oesophagus and oesophageal adenocarcinoma and squamous cell cancer.
Additional affiliations
April 2016 - present
Guy's and St Thomas' NHS Foundation Trust
Position
  • Consultant
October 2013 - present
University of Cambridge
Position
  • PostDoc Position
April 2010 - October 2013
University of London
Position
  • PhD Student
Education
September 1995 - July 2001
University of Cambridge and UCL
Field of study

Publications

Publications (93)
Article
Full-text available
Background Low‐quality evidence suggests that pre‐operative exclusive enteral nutrition (E/EN) can improve postoperative outcomes in patients with Crohn's disease (CD). It is not standard practice in most centres. Aims We aimed to test the hypothesis that pre‐operative EN in patients undergoing ileal/ileocolonic surgery for CD is associated with i...
Article
Full-text available
Purpose Long-lasting symptoms and reductions in quality of life are common after oesophago-gastric surgery. Post-operative follow-up has traditionally focussed on tumour recurrence and survival, but there is a growing need to also identify and treat functional sequelae to improve patients’ recovery. Methods An electronic survey was circulated via...
Article
Background COVID-19 has severely affected UK endoscopy services with an estimate 86% loss of activity during the first wave. Subsequent delays in diagnostic and surveillance procedures highlight the need for novel solutions to tackle the resultant backlog. Transnasal endoscopy (TNE) provides an attractive option compared with conventional upper gas...
Article
Objective Monitoring of key performance indicators (KPIs) is a vital element of endoscopy quality improvement. Adenoma detection rate (ADR) is considered the best marker for colonoscopic quality as it inversely correlates with subsequent colonic cancer incidence and mortality, while polyp detection rate (PDR) is an easier-to-calculate surrogate for...
Article
Background and aim With the increasing use of endoscopic mucosal resection (EMR) for the staging and management of early oesophageal cancer (EOC), the value of multiple staging investigations remains clear. Methods A single centre, ethically approved, prospective database of patients treated for EOC between 2000 and 2018 was analysed. This incorpo...
Article
Background Long-lasting symptoms and reductions in quality of life are common after oesophago-gastric surgery. Post-operative follow-up has traditionally focussed on tumour recurrence and survival, but there is a growing need to also identify and treat functional sequelae to improve patients’ recovery. Methods An electronic survey was circulated v...
Preprint
Full-text available
Purpose: Long-lasting symptoms and reductions in quality of life are common after oesophago-gastric surgery. Post-operative follow-up has traditionally focussed on tumour recurrence and survival, but there is a growing need to also identify and treat functional sequelae to improve patients’ recovery. Methods: An electronic survey was circulated via...
Conference Paper
Introduction Eosinophilic oesophagitis (EoE) is an increasingly common disorder characterised by the accumulation of eosinophils within the oesophageal epithelium. Schatzki rings are defined as thin mucosal fibrotic rings most commonly seen at the GOJ. Schatzki rings can be mistaken for fibrotic strictures of EoE and it is therefore important to bi...
Conference Paper
Introduction Transabdominal intestinal ultrasound (IUS), best capable of detecting intestinal inflammation & associated complications proximal to the rectum, can potentially obviate the need for endoscopy in certain clinical scenarios. It is non-invasive, able to assess disease extent, can be performed at point-of-care enabling immediate therapeuti...
Conference Paper
Introduction Eosinophilic oesophagitis (EoE) is a chronic inflammatory condition of the oesophagus. The diagnosis is made in individuals presenting with dysphagia and/or food bolus impaction, based on typical endoscopic findings (expressed as EREFS score determining the severity of 5 endoscopic findings: oedema, rings, exudates, furrows and strictu...
Conference Paper
Introduction Prolonged acid reflux monitoring using wireless pH monitoring (WPM) may be performed following pH impedance in suspected false negative cases. The increased yield of Gastro-esophageal reflux disease (GERD)-positive diagnoses with WPM is unknown. Also unknown is which parameters from the negative pH impedance or manometry, may predict a...
Conference Paper
Introduction Limited data exist on the safety of fundoplication surgery in patients with oesophageal aperistalsis, with some considering it a contraindication due to risk of dysphagia. We aimed to assess rates & predictors of dysphagia in such patients who underwent fundoplication. Methods Patients with oesophageal aperistalsis based on the Chicag...
Conference Paper
Introduction Trans-nasal endoscopy (TNE) using an ultra-thin endoscope has been shown to be safe and tolerable. In the COVID era, capacity in endoscopy is limited both in rooms due to backlogs and staff shortages, and in recovery due to social distancing. TNE is advantageous over conventional OGD (c-OGD) as it requires fewer nursing staff, no need...
Conference Paper
Introduction Although dysphagia should be considered a high-risk symptom for cancer referral pathways, the yield of endoscopy for cancer is currently <5%. Even prior to the COVID-19 pandemic, this was a significant burden for endoscopy units and subjected patients to inappropriate concern at being referred and investigated for suspected cancer. The...
Conference Paper
Introduction Dedicated Barrett’s oesophagus (BO) surveillance endoscopy lists improve dysplasia detection. However, the decision when to endoscopically survey a patient is often done by non-experts. Since 2014, the guidelines regarding surveillance timing have changed and guidance is now based on the length of the maximum extent of the Barrett’s se...
Article
To assess the outcomes of patients with early esophageal cancer (EEC) and high-grade dysplasia (HGD) comparing esophagectomy, the historical treatment of choice, to endoscopic eradication therapy (EET). Methods Retrospective cohort study of consecutive patients with EEC/HGD, treated between 2000 and 2018 at a tertiary referral centre. Primary outc...
Article
Background: To assess the outcomes of patients with early esophageal cancer and high-grade dysplasia comparing esophagectomy, the historical treatment of choice, to endoscopic eradication therapy (EET). Methods: Retrospective cohort study of consecutive patients with early esophageal cancer/high-grade dysplasia, treated between 2000 and 2018 at...
Article
A high Mandard score implies a non-response to chemotherapy in oesophageal adenocarcinoma. However, some patients exhibit tumour volume reduction and a nodal response despite a high score. This study examines survival and recurrence patterns in these patients. Clinicopathological factors were analysed using multivariable Cox regression assessing ti...
Article
Objective Acid exposure time (AET) from ambulatory pH studies and reflux oesophagitis are independent measurements used by the Lyon classification to diagnose GORD. This study aimed to validate AET reference ranges and diagnostic thresholds by analysis of 96-hour wireless pH studies from healthy, asymptomatic controls (HCs) and patients with and wi...
Conference Paper
Introduction Eosinophilic Oesophagitis (EoE) is a chronic allergic disorder of the oesophagus, associated with an inflammatory infiltrate of eosinophils into the oesophagus, and associated with submucosal fibrosis and dysphagia. A high index of suspicion is needed at endoscopy and targeted biopsies from areas of mucosal abnormality in addition to s...
Conference Paper
Introduction Monitoring of key performance indicators (KPIs) is paramount to standardise and improve quality in endoscopy. Adenoma detection rate (ADR) is considered the best surrogate marker for colonoscopic diagnostic accuracy, having been inversely associated with interval cancer risk and mortality. Polyp detection rate (PDR) is easier to calcul...
Conference Paper
Introduction The cervical inlet patch (CIP) is an island of heterotopic gastric mucosa, most commonly found in the proximal oesophagus. Its importance as a cause of throat symptoms has been recognised, particularly chronic globus.Studies report variable figures regarding the prevalence of heterotopic gastric mucosa in the proximal oesophagus, betwe...
Article
Background To quantify the effects of COVID‐19 on our inflammatory bowel disease (IBD) unit, including service provision, prescribing practices and use of therapeutic drug monitoring (TDM). Methods We performed a single centre retrospective observational cohort study. Data was extracted from our IBD database, electronic patient records and radiolo...
Article
Full-text available
Aim This study aimed to compare the efficacy and safety of LHM and POEM for esophageal achalasia. Background & Methods Laparoscopic Heller’s myotomy (LHM) has been the gold standard of treatment, however per-oral endoscopic myotomy (POEM) was recently established as a treatment option for achalasia. A prospective review was performed for all patie...
Article
Aim To compare Oesophagectomy and Endoscopic mucosal resection (EMR) short and long term outcomes of patients treated for early oesophageal cancer over a transition period in a single institution. Background and Methods Introduction of Endoscopic eradication therapy (EET) techniques in 2012 provided an alternative to oesophagectomy for high grade...
Article
Full-text available
Aim Assessment of the clinical outcomes, resolution of dysphagia, incidence of postoperative gastro-oesophageal reflux disease (GORD), and quality of life (QoL) of patients after POEM. Background&Methods POEM is increasingly performed worldwide for treatment of achalasia proving itself effective and safe. From a prospective database of all POEM’s...
Article
Full-text available
Background: A positive circumferential resection margin (CRM) has been associated with higher rates of locoregional recurrence and worse survival in oesophageal cancer. The aim of this study was to establish if clinicopathological and radiological variables might predict CRM positivity in patients who received neoadjuvant chemotherapy before surge...
Conference Paper
Introduction Patients with inflammatory bowel disease (IBD) are likely to undergo multiple lifetime endoscopic procedures which generate histopathological reports. Managing these patients requires clinicians to derive a phenotypic overview from numerous episodes and diverse sources which can be time consuming, incomplete and subjective. We set out...
Conference Paper
Full-text available
Introduction Achalasia is a rare disorder with several treatment options. Laparoscopic Heller’s myotomy (LHM) has been the gold standard of treatment, however per-oral endoscopic myotomy (POEM) was recently established as a treatment option in achalasia proving itself an effective and safe procedure. The aim of this study was to summarize and compa...
Conference Paper
Introduction Patients with Barrett’s oesophagus (BE) undergo regular endoscopic surveillance with a view to earlier oesophageal adenocarcinoma detection. Quality monitoring of this programme relies on manual extraction of elements from pathology and endoscopic semi-structured free text reports. Manual extraction is laborious and a significant hindr...
Article
Full-text available
Cancers occurring at the gastro‐esophageal junction (GEJ) are classified as predominantly esophageal or gastric, which is often difficult to decipher. We hypothesised that the transcriptomic profile might reveal molecular subgroups which could help to define the tumor origin and behaviour beyond anatomical location. The gene expression profiles of...
Article
Progression from Barrett's esophagus (BE) to esophageal adenocarcinoma (EAC) is uncommon but the consequences are serious. Predictors of progression are essential to optimize resource utilization. This study assessed the utility of a promising panel of biomarkers applicable to routine paraffin embedded biopsies (FFPE) to predict progression of BE t...
Article
In the past decade there have been technological advances in Endoscopic Eradication Therapy (EET) for the management of patients with oesophageal neoplasia and early cancer. Multiple endoscopic techniques now exist for both squamous and Barrett's oesophagus associated neoplasia or early cancer. A fundamental aspect of endotherapy is removal of the...
Article
Dietary intervention is effective for the management of eosinophilic oesophagitis (EoE) in both adults and children [1]. The majority of research has been conducted in Spain or the United States [1], with no studies of dietary intervention published in the United Kingdom. Restrictive elimination diets can be challenging and swallowed topical cortic...
Preprint
Full-text available
Large-scale cancer genome studies suggest that tumors are driven by somatic copy number alterations (SCNAs) or single-nucleotide variants (SNVs). Due to the low-cost, the clinical use of genomics assays is biased towards targeted gene panels, which identify SNVs. There is a need for a comparably low-cost and simple assay for high-resolution SCNA pr...
Conference Paper
Introduction Radio-frequency ablation (RFA) for the treatment of Barrett’s oesophagus (BE) related neoplasia ablative intervention after endoscopic resection (ER)For circumferential BE, the 3 cm HALO 360.balloon used to treat large areas. A new device, the HALO 360 Express self-sizing catheter was recently launched and can potentially allow quicker...
Conference Paper
Full-text available
Introduction Oesophageal aperistalsis (OA) is the absence of oesophageal motility with water swallows at high-resolution manometry (HRM). The main causes are achalasia and reflux although in many patients no cause is found, therefore we aimed to investigate the number of patients with an identifiable cause of OA and the number of patients in whom t...
Conference Paper
Introduction The incidence of eosinophilic oesophagitis (EoE) is increasing. Following diagnosis, the initial therapy is to place patients on protein pump inhibitors (PPI) and repeat oesophageal biopsies, as 30% of patients will be PPI responsive. As acid reflux is known to cause eosinophilic oesophagitis, pH impedance and manometry is also carried...
Conference Paper
Introduction Most electronically stored endoscopic reports consist of semi-structured free text. containing a significant amount of auditable information. However, the unstandardised text requires cleaning prior to audit so that the data is standardised across patients. One major obstruction to the automated auditing of free text is phrases that me...
Conference Paper
Full-text available
Introduction Endoscopic resection (ER) is the preferred initial treatment for early cancer and dyplasia with visible lesions arising in Barrett’s oesophagus (BE). An intra-procedural bleeding risk of 10% is typically quoted, with most controlled by endoscopic intervention. There is little data on risk factors for bleeding during oesophageal pieceme...
Article
Full-text available
Uvular necrosis is an extremely rare complication of gastroscopy. We describe the fifth published case of uvular necrosis following an uncomplicated diagnostic gastroscopy in a young man. Presentation with severe sore throat and inability to swallow saliva occurred within 24 hours of gastroscopy and resolved with conservative treatment. © BMJ Publi...
Conference Paper
Full-text available
Introduction Eosinophilic oesophagitis (EoE) is an inflammatory condition characterised by symptoms of oesophageal dysfunction (typically dysphagia and food bolus obstruction) and at least 15 eosinophils/hpf on oesophageal biopsy. Although there are endoscopic features associated with EoE, 10%–25% of endoscopies in patients with this condition will...
Conference Paper
Introduction Management of eosinophilic oesophagitis (EoE) includes proton pump inhibitors (PPIs), topical steroids, or dietary intervention. In adults dietary management commonly consists of either the six-food elimination diet (SFED) or allergy-test directed food exclusion. To date patient characteristics and outcomes from various interventions h...
Conference Paper
Full-text available
Introduction The gold standard for diagnosis of primary oesophageal dysmotility (POD) is high-resolution manometry (HRM). Barium swallow (BS) studies remain integral to many diagnostic algorithms for dysphagia. Our aim was to assess the sensitivity and specificity of BS in the diagnosis of POD including achalasia as defined using HRM. Method Patie...
Conference Paper
Introduction Endoscopic Therapy for T1a oesophageal adenocarcinoma (OAC), and some T1b with favourable pathological features (sm1, no LVI, G1 or G2 differentiation), is now the recommended standard of care by BSG. Many endotherapy centres have large geographic catchment areas, so accurate staging for these early cancers is crucial to avoid unnecess...
Article
Full-text available
The scientific community has avoided using tissue samples from patients that have been exposed to systemic chemotherapy to infer the genomic landscape of a given cancer. Esophageal adenocarcinoma is a heterogeneous, chemoresistant tumor for which the availability and size of pretreatment endoscopic samples are limiting. This study compares whole-ge...
Chapter
In-depth molecular characterization of esophageal oncogenesis has improved over the recent years. Advancement in molecular biology and bioinformatics has led to better understanding of its genomic landscape. More specifically, analysis of its pathogenesis at the genetic level has uncovered the involvement of a number of tumor suppressor genes, cell...
Article
Introduction Barrett’s oesophagus is a premalignant condition for the development of oesophageal adenocarcinoma. Guidelines have been established to guide which patients should be included in endoscopic surveillances schemes. We evaluated the clinico-pathological characteristics of patients under surveillance at our tertiary referral centre includi...
Article
Full-text available
Barretts oesophagus represents the most significant risk factor for the development of oesophageal adenocarcinoma (OAC), although the majority of patients will not develop cancer. However, early detection of OAC and its precursors significantly improves outcome and underlines the importance of endoscopic surveillance programmes. Clearly there is a...
Article
The ability to stratify patients based on the risk of progression to oesophageal adenocarcinoma would provide benefit to patients as well as deliver a more cost effective surveillance programme. Current practice is to survey all patients with Barrett's oesophagus (BO) and use histological diagnoses to guide further management. However, reliance on...
Article
Full-text available
Cancer genome sequencing studies have identified numerous driver genes, but the relative timing of mutations in carcinogenesis remains unclear. The gradual progression from premalignant Barrett's esophagus to esophageal adenocarcinoma (EAC) provides an ideal model to study the ordering of somatic mutations. We identified recurrently mutated genes a...
Article
Introduction Patients undergoing upper GI endoscopy (OGD) are often on chronic PPI therapy for dyspeptic symptoms or gastro-oesophageal reflux disease (GORD). Continued PPI therapy at the time of the endoscopy can influence the outcome of H. pylori testing via rapid urease test (CLO) or even histology. In addition, complete response to PPI in patie...
Article
Full-text available
Barrett's oesophagus (BO) is a usually indolent condition that occasionally requires endoscopic therapy. Radiofrequency ablation (RFA) is an effective endoscopic treatment for high grade dysplasia (HGD) and intramucosal cancer in BO. It has a good efficacy, durability and safety profile although complications can occur. Here we describe a case of R...
Article
Full-text available
Barrett's oesophagus shows appearances described as 'intestinal metaplasia', in structures called 'crypts' but do not typically display crypt architecture. Here, we investigate their relationship to gastric glands. Cell proliferation and migration within Barrett's glands was assessed by Ki67 and iododeoxyuridine (IdU) labelling. Expression of mucin...
Article
Epithelial dysplasia is an important histologic diagnosis, signifying the presence of pre-invasive disease, usually needing intervention. However, the specific genetic changes responsible for the induction of this phenotypic change are unknown. Moreover, recent reports indicate that the dysplastic phenotype may not be immutable: in basal crypt dysp...
Article
Full-text available
Objectives: Radiofrequency ablation (RFA) is used to successfully eliminate Barrett's esophagus (BE)-related dysplasia or intramucosal carcinoma and aims to cause reversion to squamous epithelium. However, in 20% of cases RFA fails to return the epithelium to squamous phenotype. Follow-up studies show a similar dysplasia recurrence rate. We hypoth...
Article
Introduction Dysplasia in epithelia is an important histological diagnosis although the specific genetic changes which are responsible for this phenotypic change are unknown. Recent reports indicate that the dysplastic phenotype may not be immutable: in basal crypt dysplasia like atypia (BCDA), unequivocal dysplasia is seen in the crypts in Barrett...
Article
The heterogeneous clonal populations characterizing premalignant Barrett's oesophagus predispose to carcinogenesis suggesting a prominent but unelucidated role of clonal interactions. One mechanism may be paracrine signalling from clonal senescent Barrett’s cells (SBC) effecting non-senescent cell (NSBC) expansion. The study assessed the presence...
Article
Epithelial stem cells are typically multipotential and are likely the cell of origin of epithelial cancers. Tracing the expansion of a single stem cell's progeny, identifying and characterizing these cells in human tissue has proven difficult. Invasive labeling studies, which have led to much success in model organisms, are impracticable in humans....
Article
Introduction Barrett's oesophagus (BO) is a common premalignant condition, wherein the normal squamous oesophageal epithelium is replaced by a columnar, intestinal phenotype. It is the predominant risk factor for the development of oesophageal adenocarcinoma (OA)1 which develops through a metaplasia: dysplasia: carcinoma sequence. Initial studies s...
Article
Introduction Radiofrequency ablation (RFA) is a relatively new endoscopic method for ablation of high grade dysplasia (HGD) and intramucosal adenocarcinoma (IMC) in Barrett's oesophagus. Clinical trials have shown enduring eradication of these pathologies.1 However, some patients develop recurrent dysplasia or cancer.1 The reason for this is unknow...