Updated German guideline on diagnosis and treatment of squamous cell carcinoma and adenocarcinoma of the esophagus.

Diagnosis and therapy of esophageal carcinoma is challenging and requires a multidisciplinary approach. The purpose of the updated German guideline "Diagnosis and Treatment of Squamous Cell Carcinoma and Adenocarcinoma of the Esophagus-version 3.1" is to provide practical and evidence-based advice for the management of patients with esophageal cancer. Recommendations were developed by a multidisciplinary expert panel based on an extensive and systematic evaluation of the published medical literature and the application of well-established methodologies (e.g. Oxford evidence grading scheme, grading of recommendations). Accurate diagnostic evaluation of the primary tumor as well as lymph node and distant metastases is required in order to guide patients to a stage-appropriate therapy after the initial diagnosis of esophageal cancer. In high-grade intraepithelial neoplasia or mucosal carcinoma endoscopic resection shall be performed. Whether endoscopic resection is the definitive therapeutic measure depends on the histopathological evaluation of the resection specimen. Esophagectomy should be performed minimally invasive or in combination with open procedures (hybrid technique). Because the prognosis in locally advanced esophageal carcinoma is poor with surgery alone, multimodality therapy is recommended. In locally advanced adenocarcinomas of the esophagus or esophagogastric junction, perioperative chemotherapy or preoperative radiochemotherapy should be administered. In locally advanced squamous cell carcinomas of the esophagus, preoperative radiochemotherapy followed by complete resection or definitive radiochemotherapy without surgery should be performed. In the case of residual tumor in the resection specimen after neoadjuvant radiochemotherapy and R0 resection of squamous cell carcinoma or adenocarcinoma, adjuvant immunotherapy with nivolumab should be given. Systemic palliative treatment options (chemotherapy, chemotherapy plus immunotherapy, immunotherapy alone) in unresectable or metastastic esophageal cancer depend on histology and are stratified according to PD-L1 and/or Her2 expression.

[Survey: Why did you become a gastroenterologist?] / Umfrage: Was hat Sie dazu bewogen, die Gastroenterologie als Fachgebiet auszuwählen?

INTRODUCTION: The specific support of medical students is indispensable in gastroenterology. The aim of this study was to identify factors that influenced members of the German Society of Gastroenterology, Digestive and Metabolic Diseases (DGVS) to choose their specialty. METHODS: Using an online survey all members of the DGVS were invited to assess the following factors: earliest time point of the decision to become a gastroenterologist, important role models and mentors, important course contents and teaching methods, the role of the doctoral thesis and other influencing aspects of the specialty gastroenterology. The evaluation included an additional subgroup analysis involving work experience (≤ 8, 9-29, ≥ 30 years) and working place (university hospital, community-based hospital, private practice). RESULTS: 1358 participants representing 24.2 % of the DGVS-members took part in the survey. Physicians with ≤ 8 years of work experience decided in 62.5 % during medical school to become a gastroenterologist compared to 37.1 % of the physicians with a work experience of ≥ 9 years (p < 0.001). Senior physicians were regarded as important role models and mentors by 40.8 % of the participants. Doctoral supervisors were regarded as important mentors that influenced the selection of the specialty by 42.8 % of the participants that completed their doctoral thesis in gastroenterology. Hands-on courses like sonography were regarded as important course contents by 42.2 % of the participants. Interventional medicine in particular endoscopy and the diversity of gastroenterology were rated as important in the selection process for the specialty. CONCLUSION: The decision to become a gastroenterologist is mainly made during medical school. The main influencing role models and mentors are senior physicians. Hands-on training in ultrasound and endoscopy were regarded as important course contents and teaching methods.