Esophagus

Question 1

Tx of epiphrenic diverticula of esophagus?

Answer 1

If symptomatic—> stapled diverticulectomy, myotomy on opposite side of esophagus, dor/toupet fundoplication

Question 2

Cause of achalasia?

Answer 2

Degeneration of intramural ganglion cells

Question 3

Barretts esophagus without dysplasia; how do we manage?

Answer 3

Serial surveillance with EGD every 3-5 years with 4 quadrant biopsies every 2 cm

Question 4

Circular membrane of mucosa and submucosa at the squalocolulmnar junction of distal esophagus that causes intermittent dysphagia;

Answer 4

Schatzkis ring

Thought to be caused by GERD

Always associated with a hiatal hernia

Initial work up involves a barium esophagram, followed by EGD

Question 5

Tx of epiphrenic diverticula?

Answer 5

Transthoracic diverticulectomy

180 degree esophagomyotomy opposite the diverticula

Partial wrap

Question 6

Cause of Schatzki ring?

Answer 6

GERD

Always assc with hiatal hernia

Question 7

First step in work up of a Schatzkis ring?

Answer 7

Barium esophagram

Question 8

Cancers of proximal and middle esophagus are more likely to be;

Answer 8

SCC

**distal esophagus more likely to be adenoca

Question 9

Main risk factors for developing SCC of esophagus?

Answer 9

Smoking
Etoh
Male sex

Question 10

Esophageal cancer located <5 cm from cricopharyngeus; how do we treat?

Answer 10

Definitive chemoradiation

Question 11

Barretts esophagus without dysplasia screening?

Answer 11

3-5 years

Question 12

Tx of Barrett’s esophagus with low grade dysplasia?

Answer 12

Endoscopic mucosal resection

Question 13

Barretts with high grade dysplasia has what risk of cancer annually?

Answer 13

5%

Question 14

Epiphrenic diverticula:

Answer 14

Distal 1/3 of esophagus
False diverticula; get herniation of mucosa and submucosa

If sx performed; diverticulectomy with esophagomyotomy (there is usually an underlying motility disorder)

Question 15

Gold standard to diagnose GERD?

Answer 15

Esophageal pH probe

Question 16

Someone has a heller myotomy for achalasia with partial fundoplication; 3-6 months later they still experience reflux with a DeMeester score >14.72; what’s next?

Answer 16

Lifelong PPI therapy

Converting to a full Nissen wrap risks causing a mechanical obstruction

Question 17

For esophageal ca, what modality is best at detecting local regional lymph node involvement?

Answer 17

EUS

Question 18

Blood supply to esophagus;

Answer 18

Cervical; inferior thyroid artery
Thoracic; bronchial arteries and aortic branches
Abdominal; left gastric a & inferior phrenic artery

Question 19

A proper Heller myotomy involves what margins;

Answer 19

6 cm on esophagus
2 cm on stomach

Question 20

Swallowing center located where?

Answer 20

Medulla

Question 21

TNM of esophageal ca;

Answer 21

T1b; invaded submucosa
T2; invades muscularis
T3; invades adventitious
T4a; pleura pericardium, diaphragm
T4b; unresectable, involves aorta, vertebral body, trachea

N1; 1-2
N2; 3-6
N3; >7

Question 22

You perform and EGD and identify a Schaztkis ring; what to do next?

Answer 22

Biopsy and rule out eosinophilia esophagitis

If negative, then can dilate

If positive, start medical treatment for eosinophilic esophagitis; dilation if medical therapy fails

Question 23

Leiomyoma of esophagus

Answer 23

Benign slow growing lesions of esophagus that can cause dysphagia even at smaller sizes
Enucleation is treatment of choice of symptomatic leiomyomas

Question 24

Corkscrew appearance on esophagram?

Answer 24

Diffuse esophageal spasm

Question 25

Narrowest point of esophagus is at?

Answer 25

Cricopharyngeus muscle