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What is Barrett’s Esophagus?
Metaplasia of esophageal squamous epithelium into columnar in distalQ esophagus
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Risk factors for adenocarcinoma esophagus?
- • GERD (leading to Barrett’s esophagusQ)
- • ObesityQ
- • SclerodermaQ
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Risk factors for squamous cell carcinoma esophagus?
- • AlcoholQ
- • SmokingQ
- • Ingested carcinogens
- • Plummer vinson syndrome
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H. Pylori and carcinoma esophagus?
CAG-A positive strain is protective for adenocarcinoma esophagus but can lead to SCC of esophagusQ
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MC esophageal cancer worldwide?
Squamous cell carcinomaQ
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MC esophageal cancer in United States (Western countries)?
AdenocarcinomaQ
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MC site of CA esophagus?
- Middle 1/3rd (Overall)Q
- SCC – Middle one third
- Adenocarcinoma – lower one third
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Treatment of squamous and adenocarcinoma?
- Squamous cell - Treated aggressively with nonsurgical therapyQ
- Adenocarcinoma - Treated by a more aggressive surgical approachQ.
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MC symptom of carcinoma esophagus?
Dysphagia >Weight lossQ
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Diagnosis of carcinoma esophagus?
- • Barium swallow: First investigation doneQ in suspected case of CA esophagus (classic finding of an apple core lesionQ)
- • Endoscopy with biopsy: Investigation of choice for diagnosis of CA esophagusQ.
- • Endoscopic Ultrasound: Investigation of choice for staging of CA esophagus, best for T staging and LN metastasisQ.
- • CECT (abdomen and chest): metastasis to liver and lungsQ
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SiewertQ classification GE junction tumors?
- Type I – within 1-5 cm above from GE junction
- Type II – from 1 cm above, 2 cm below GE junction
- Type III – From 2-5 cm caudal to GE junction
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Features of Malignant Lymph Nodes on EUS?
- • Echo-poor (hypoechoic)Q structure
- • Sharply demarcated bordersQ
- • Rounded contourQ
- • Size >1 cmQ
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Palliation Therapy in Carcinoma Esophagus?
- • Laser TherapyQ
- • Photodynamic TherapyQ
- • Radiation TherapyQ
- • SEMSQ (Self expandable metallic stent)
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Features of CA Esophagus on Barium Swallow?
- • Mucosal irregularity and shoulderingQ
- • NarrowingQ of the lumen
- • Irregular “rat-tail” filling defectQ of the distal esophagus with shouldered edgeQ
- • Annular strictureQ
- • Sharp and clear cut edge of filling defectQ
- • Proximal dilatationQ of the esophagus
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Best conduit after esophagectomy (overall)?
StomachQ
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Conduit of choice after esophagectomy in CA esophagus?
StomachQ
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Conduit of choice after esophagectomy in benign disorders (caustic injuries, acid-peptic disease), unhealthy stomach?
ColonQ
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Conduit of choice for short segment replacement?
JejunumQ
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Gastric conduit is based on which vessel?
Right gastric and right gastroepiploic vesselsQ
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Left colon is based on which vessel?
Left colic artery (Branch of IMA), placed in isoperistaltic direction.
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What is Orringer Transhiatal Esophagectomy?
- • Double incision: Midline laparotomy followed by cervical incisionQ
- • Cervical anastomosis is doneQ
- • MC procedure done for carcinoma esophagusQ
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What is Ivor-Lewis procedure?
- • Transthoracic esophagectomyQ
- • Double incision: Midline laparotomy followed by right sided thoracotomyQ
- • Done for tumors of middle 1/3rd of esophagusQ
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What is McKeon procedure?
- • En-bloc esophagectomyQ
- • Three incisions: Right sided thoracotomy, followed by midlineQ laparotomy, followed by cervical incisionQ
- • Associated with maximum morbidity and mortalityQ
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Tumor Margin for Curative Excision?
- In GI malignancies (stomachQ, small intestineQ, colonQ and proximal rectumQ), tumor margin for curative excision is 5cmQ except:
- − Esophagus: 10 cmQ
- − Distal rectum: 2 cmQ
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Complications of Esophagectomy?
- • Anastomotic Leak (MC)Q
- • Anastomotic stricture
- • Pulmonary complications
- • Recurrent laryngeal nerve palsy
- • Chylothorax
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MC benign esophageal tumorQ?
Leiomyoma
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