Sebastian S Zeki

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

Background Ineffective oesophageal motility (IOM) is a minor motility disorder that is commonly found in patients. The IOM diagnosis is based on heterogenous combination of failed peristalsis, weak peristalsis activity and peristaltic defects that are observed during the stimulation to 5mL standard water swallows. IOM is implicated to post-surgical...

Background Patients frequently experience symptoms after major oesophagogastric (OG) cancer resection which can delay quality of life resolution. Multiple symptoms can arise simultaneously making diagnosis of the underlying problem(s) and subsequent treatment complex. While diagnostic tests can offer valuable insight, some conditions are treated em...

Background Major upper gastro-intestinal (UGI) cancer surgery in combination with chemotherapy offers the best chance of cure for patients with oesophageal and gastric cancer. However, these treatments have significant long-term side-effects resulting in a high symptom burden in this patient group. This adversely affects quality of life and places...

Background Preoperative assessment for magnetic sphincter augmentation (MSA) (LINX) involves evaluating the Mean Distal Amplitude (MDA) on conventional manometry to assess the patient suitability and risk of post-operative dysphagia. In the last decade high-resolution manometry (HRM) has superseded conventional manometry owing to obtaining more cli...

Background Oesophago-gastric (OG) cancer surgery is life-changing with a significant impact on quality of life (QOL). OG cancer surgery reconfigures the upper gastrointestinal (GI) tract altering its physiological function. Certain disorders such as anastomotic stricture are well recognised whereas others, such as small intestinal bacterial overgro...

Background Absent contractility (AC) is a major motility disorder with poor prognosis. Surgical management for associated comorbidities of AC are often challenging such as in GORD patients where antireflux surgery may be contraindicated or undiagnosed achalasia manifesting with normotensive integrated relaxation pressure would be deprived of surgic...

Background Patient symptom burden following oesophago-gastrectomy is high with numerous potential underlying causes which can often overlap. Diagnostic test results and the symptom response to a given intervention may provide important insights, yet there are no validated questionnaires to support the latter. Delayed gastric emptying is a common pr...

Introduction Just under half of patients with obstructive sleep apnoea (OSA) also have gastro-oesophageal reflux disease (GORD). These conditions appear to be inter-related and continual positive airway pressure (CPAP) therapy, the gold standard treatment for OSA to prevent airway collapse, has been shown to reduce GORD. As the impact of mandibular...

Introduction Fundic gland polyps are the most frequently encountered type of gastric polyp (13–77%),1 2 and, whilst they are typically <1cm, those >1cm carry both a reported dysplasia rate and focal cancer rate of 1.9%; therefore, it has been suggested that fundic gland polyps >1cm should be resected or undergo targeted biopsy,³ which consequently...

Introduction Multichannel impedance-pH (MII-pH) monitoring has series of impedance sensors that detect intraoesophageal antegrade bolus movements during swallows. We hypothesis this feature would permit oesophageal transit measurements. Method Patients rapidly drank 200ml of saline (or as much as possible) within 20 seconds during the start of the...

Background & Aims The role of inhaled and subsequently swallowed aeroallergens in treatment outcomes of adults with eosinophilic esophagitis (EoE) is unclear. We hypothesized that the pollen season contributes to the failure of dietary therapy in EoE. In this international two-centre study, we compared six-food elimination diet (SFED) outcomes of E...

Background and Aims Dysphagia is a possible complication of anti-reflux surgery. Whether absent peristalsis on pre-operative esophageal high-resolution manometry (HRM) increases the risk of post-operative dysphagia is unclear. We compared dysphagia and gastro-esophageal disease (GERD) outcomes in patients with absent peristalsis and normal motility...

Background and Aims Eosinophilic esophagitis (EoE) and gastroesophageal reflux disease (GERD) may coexist. The role of GERD in histologically PPI (proton pump inhibitors)-refractory (PPI-R) EoE has been poorly investigated. We characterized ambulatory reflux monitoring findings and heartburn outcomes in PPI-R EoE patients undergoing 96-h wireless p...

Introduction The bidirectional relationship between IBD and mental health is increasingly recognised. There are also IBD related experiences which may negatively impact on patients’ mental health. IBD management guidance (2019) calls for services to be more integrated in their approach to mental and physical health management. We wanted to assess w...

Introduction: The role of inhaled and swallowed aeroallergens in treatment outcomes of adult patients with eosinophilic esophagitis (EoE) is unclear. We hypothesized that the pollen season contributes to the failure of the six-food elimination diet (SFED) in EoE. Aims methods: We compared outcomes of EoE patients who underwent SFED during versus...

The clinical value of multiple staging investigations for high-grade dysplasia or early adenocarcinoma of the esophagus is unclear. A single-center prospective cohort of patients treated for early esophageal cancer between 2000 and 2019 was analyzed. This coincided with a transition period from esophagectomy to endoscopic mucosal resection (EMR) as...

Background: The Lyon Consensus designates Los Angeles (LA) grade C/D esophagitis or acid exposure time (AET) >6% on impedance-pH monitoring (MII-pH) as conclusive for gastroesophageal reflux disease (GERD). We aimed to evaluate proportions with objective GERD among symptomatic patients with LA grade A, B, and C esophagitis on endoscopy. Methods:...

Objective The second iteration of the Selecting Therapeutic Targets in Inflammatory Bowel Disease (STRIDE-II) initiative recommends use of the Simple Endoscopic Score for Crohn’s disease (SES-CD) as a treatment target for patients with CD. We aimed to assess whether the STRIDE-II endoscopic endpoints are achievable and whether the degree of mucosal...

The clinical value of multiple staging investigations for high-grade dysplasia (HGD) or early adenocarcinoma of the oesophagus (EOC) is unclear. A single centre prospective cohort of patients treated for EOC between 2000 and 2019 was analysed. This coincided with a transition period from oesophagectomy to endoscopic mucosal resection (EMR) as the t...

Background Somatic copy number alterations (SCNAs) are an important class of genomic alteration in cancer. They are frequently observed in cancer samples, with studies showing that, on average, SCNAs affect 34% of a cancer cell’s genome. Furthermore, SCNAs have been shown to be major drivers of tumour development and have been associated with respo...

Objective Intestinal ultrasound (IUS) is an inexpensive, non-invasive method of diagnosing and monitoring inflammatory bowel disease (IBD). We aimed to establish the proportion of lower gastrointestinal endoscopies (LGIEs) and magnetic resonance enterographies (MREs) that could have been performed as IUS, the potential pathology miss-rates if IUS w...

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...

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...

Introduction The UCEIS is a validated index that can be used to accurately measure endoscopic disease activity in Ulcerative Colitis. The IOIBD STRIDE initiative recommended a composite UC treatment target consisting of both clinical and endoscopic remission. However, there exists no widely accepted definition for endoscopic remission using UCEIS....

Introduction Multichannel channel impedance-pH (MII-pH) monitoring has affiliated PSPW with reflux clearance/restoration of neutral oesophageal pH, which is a novel marker for gastrooesophageal reflux disease (GORD).1–3 PSPW incidence has not been studied alongside 96-hours of wireless Bravo pH (WBpH) monitoring which this paper will address. Meth...

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...

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...

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...

Background The Selecting Therapeutic Targets in Inflammatory Bowel Disease (STRIDE) initiative provides recommendations on treatment targets for patients with Crohn’s disease (CD). The Simple Endoscopic Score for CD (SES-CD) is a validated endoscopic score and STRIDE-II recommends its use in clinical practice. We aimed to assess whether the STRIDE-...

Background Low quality evidence suggests that pre-operative exclusive enteral nutrition (E/EN) can improve post-operative outcomes in patients with small bowel Crohn’s disease (CD). It is not standard practice in most centres. We aimed to test the hypothesis that pre-operative EN in patients undergoing surgery for CD is associated with improved pos...

Background The Tumor Location-Modified Laurén Classification (MLC) system combines Laurén histologic subtype and anatomic tumor location. It divides gastric tumors into proximal non-diffuse (PND), distal non-diffuse (DND), and diffuse (D) types. The optimum classification of patients with Laurén mixed tumors in this system is not clear due to its g...

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...

Background: 18F-fluorodeoxyglucose positron emission tomography/magnetic resonance imaging (18F-FDG PET/MRI) may improve cancer staging by combining sensitive cancer detection with high-contrast resolution and detail. We compared the diagnostic performance of 18F-FDG PET/MRI to 18F-fluorodeoxyglucose positron emission tomography/computed tomograph...

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...

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...

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...

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...

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...

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...

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...

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...

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...

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...

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...

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...

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...

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...

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...

Introduction Location and Behaviour are important considerations in the phenotypic characterisation of Crohn’s disease. Although enteroscopy and video capsule endoscopy allow direct visualisation of the small bowel mucosa, radiographic examinations (CT and MRI) are less invasive and provide additional information in stricturing and penetrating dise...

Introduction Squamous cell carcinoma (SCC) of the oesophagus often presents at a late stage with dysphagia symptoms. Chemoradiation (definitive or neoadjuvant treatment) remains the standard strategy for the treatment of localised SCC. Accurate radiotherapy target delineation is however problematic for very early tumours that cannot be visualised o...

Introduction Technology now allows up to 96-hour wireless pH-recording in clinical practice; however, no normal values exist for this methodology. This study acquired 96-hour esophageal pH recordings in healthy controls (HC) and compared these values against measurements in patients with endoscopic evidence of gastroesophageal reflux disease (GORD)...

Introduction Proton pump inhibitors (PPIs) are widely prescribed for gastro-oesophageal reflux disease (GORD) symptoms. The ‘PPI test’ is frequently used in lieu of formal testing. It has been shown previously that, with 48 hr pH monitoring, a 2-week PPI trial has limited accuracy for GERD diagnosis. However, it is possible that restricting to 48 h...

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...

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...

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...

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...

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...

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...

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...

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...

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...

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...

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...

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...

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...

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...

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...

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...

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...

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...

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...

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...

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...

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...

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...

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...