Upper GI Surgery

Question 1

Investigations for oesophageal cancer?

Answer 1

Endoscopy

Contrast swallow

Question 2

Investigations for TNM staging of oesophageal cancer?

Answer 2

CT chest/abdomen
PET scan (M staging)
EUS - endoscopic ultrasound (T/N staging)

Question 3

Palliative treatment options for oesophageal cancer?

Answer 3

Stenting
Radiotherapy
Chemotherapy

Question 4

Best treatment option for treatable oesophageal cancer?

Answer 4

Oesophagectomy + chemotherapy

Question 5

Describe the oesophagectomy procedure

Answer 5

Resect the cancerous portion of the oesophagus
Then move the stomach proximally and create a new gastro-oesophageal anastamoses

Stomach is elongated

Question 6

Types of oesophagectomy?

Answer 6

Ivor-Lewis
Trans-hiatal
Left thoraco-abdominal

Question 7

Modifiable risk factors for stomach cancer?

Answer 7

Infection with helicobacter pylori
Alcohol
Smoking

Excessive consumption of salted fish, pickled vegetables and cured meats

Question 8

What is the ALARMS system?

Answer 8

Checklist to help decide whether to endoscope a patient with possible presentation of gastric cancer
A - Anaemia
L - Loss of weight
A - Anorexia
R - Recent onset of progressive symptoms
M - Masses and Malaena/haematemesis
S - Swallowing difficulty

If a patient has worrying ALARMS symptoms, or is >55yrs - do endoscopy

Question 9

Investigations for diagnosis of stomach cancer?

Answer 9

Endoscopy

Contrast meal

Question 10

Investigations for TNM staging of stomach cancer?

Answer 10

CT chest/abdomen

Laparoscopy (invasive)

Question 11

Treatment options for treatable stomach cancer?

Answer 11

Gastrectomy surgery

Question 12

Types of gastrectomy surgery? Difference between them?

Answer 12

1. Subtotal gastrectomy - remove diseased part of stomach and anastomose jejunum to rest of stomach (duodenum still attached to sphincter of oddi)
2. Total gastrectomy - remove entire stomach and anastomose jejunum to oesophagus (duodenum still attached to sphincter of oddi)

Question 13

Surgery options for GORD?

Answer 13

Fundoplication - Full/partial wrap of fundus around oesophagus (hiatus hernia)
About 85% report improved QOL

Question 14

Possible side effects of fundoplication?

Answer 14

Dysphagia 
Difficulty to belch/vomit 
Gas bloating 
Excess flatulence 
Diarrhoea

Question 15

What is the radical treatment option for clinical obesity above stage 1?

Answer 15

Bariatric surgery (stomach resection)