The Esophagus
E. George Elias in CRC Handbook of Surgical Oncology, 2020
Table 1 shows the TNM and staging of esophageal cancer. The esophagus is considered into three main parts that consist of four regions, namely, the cervical, upper and mid thoracic, and lower thoracic esophagus. The cervical esophagus extends from the pharyngeal-esophageal junction, i.e., the cricopharyngeal sphincter, down to the level of the thoracic inlet, which constitutes the upper one third of the esophagus. It is estimated that this part ends at about 18 cm from the upper incisors. The second part of the esophagus extends from the thoracic inlet to a point about 10 cm above the esophagogastric junction, which is at the level of the lower border of the eighth thoracic vertebrae. This point is about 31 cm from the upper incisors. The third part, which is about 10 cm in length, extends down to the esophagogastric junction, which is about 40 cm from the upper incisors. As mentioned before, cervical lymph nodes are regional lymph nodes for cervical esophagus, but are considered as distant metastasis for the intrathoracic part of the esophagus. While the cervical lymph nodes are accessible for clinical evaluation, the medistinal and paraaortic lymph nodes can be staged surgically or by CT scanning. However, all efforts should be made to obtain a histological diagnosis.
Esophageal Motility: Measures and Disorders of Esophageal Motor Function
John F. Pohl, Christopher Jolley, Daniel Gelfond in Pediatric Gastroenterology, 2014
This phase begins as food, enters the pharynx and the pressure gradient and waves are created in the pharynx. The esophageal phase is entirely involuntary. Using neural mechanisms, a relaxation of the upper esophageal sphincter is achieved, allowing for a quick, smooth passage of the bolus from pharynx to the esophagus. For a more complete understanding of the esophageal phase of swallowing, this phase is further divided into three areas, mostly based on their functions: Upper esophageal sphincter (UES).Body of the esophagus (body).Lower esophageal sphincter (LES).
Endoscopy
Larry R. Kaiser, Sarah K. Thompson, Glyn G. Jamieson in Operative Thoracic Surgery, 2017
The need for rigid esophagoscopy is rare. Achieving profi ciency with this technique is difficult nowadays. Figure 27.1 shows rigid esophagoscopy equipment—esophagoscopes (A), biopsy forceps (B), and suctioning devices (C). Its main disadvantages are that general anesthesia is required, it is technically difficult in patients with restricted cervical mobility, and there is a small rate of perforation. By comparison, the risk of perforation with diagnostic flexible esophagoscopy is negligible. When lesions are at or close to the upper esophageal sphincter, visualization and biopsy can be easier with a rigid endoscope, where a combination of general anesthesia to eliminate swallowing and a greater instrument diameter can be helpful. While some surgeons maintain that the removal of large impacted foreign bodies can be easier with a large bore rigid tube and appropriately sized grasping forceps, the wide range of instrumentation designed for use with flexible endoscopes and a semirigid overtube has largely superseded the rigid procedure.
Critical review of the evidence for a causal association between exposure to asbestos and esophageal cancer
Published in Critical Reviews in Toxicology, 2019
Michael K. Peterson, Isaac Mohar, Thuy Lam, Travis J. Cook, Anna M. Engel, Heather Lynch
The primary function of the esophagus is to transport swallowed food to the stomach (Goyal and Chaudhury 2008; Widmaier et al. 2008). The upper esophageal sphincter (the ring of skeletal muscles that surrounds the esophagus just below the pharynx), prevents air from entering the esophagus when a person is not swallowing (i.e. while breathing). During the esophageal phase of swallowing, the upper esophageal sphincter relaxes, allowing food to pass it, then contracts again (Widmaier et al. 2008; ACS 2017). The food moves down the esophagus toward the stomach “by a progressive wave of muscle contractions that proceeds along the esophagus” (peristaltic waves) (Widmaier et al. 2008, p. 544); it takes 8–10 s for one peristaltic wave to reach the stomach (Mashimo and Goyal 2006). The lower esophageal sphincter remains open and relaxed during this period of swallowing. After the food enters the stomach, the lower esophageal sphincter closes, keeping stomach acid and digestive enzymes out of the esophagus (Widmaier et al. 2008; ACS 2017). In some people, the lower esophageal sphincter is less effective, allowing gastric contents to reflux into the esophagus, causing GERD, heartburn, and, in more severe cases, ulceration, scarring, obstruction, or perforation of the lower esophagus (Widmaier et al. 2008).
Correlation between dysphonia and dysphagia evolution in amyotrophic lateral sclerosis patients
Published in Logopedics Phoniatrics Vocology, 2021
Chiara Mezzedimi, Enza Vinci, Fabio Giannini, Serena Cocca
Phonation induces a significant increase in upper esophageal sphincter (UES) pressure. This UES pressure increase is significantly higher than that of the stomach, esophagus, and lower esophageal sphincter (LES), indicating the existence of a phonation-induced UES contractile reflex. The UES pressure generated by activation of this reflex is influenced by sex [19]. The upper esophageal sphincter is comprised of the cricopharyngeal muscles (CPM), inferior pharyngeal constrictor, and the proximal cervical esophagus. CPM is controlled by medulla, thus medullary infarction may result in a failed relaxation of UES. According to Kang SH et al. [20], the occurrence of the upper esophageal sphincter (UES) dysfuction might be the first step, which in turns affect the swallowing process, resulting in pharyngo-esophageal dyssynergia, and so dysphagia.
Zenker’s diverticulum treated via per-oral endoscopic myotomy
Published in Baylor University Medical Center Proceedings, 2020
Ahmed Ebrahim, Steven G. Leeds, Jessica S. Clothier, Marc A. Ward
The cricopharyngeus muscle is the major component of the upper esophageal sphincter.2 Cricopharyngeal dysfunction can lead to a range of disorders, from mild halitosis to dysphagia and aspiration. Common complications of open myotomy in the treatment of ZD include fistula formation and recurrent nerve injury. Patients with ZD also tend to be elderly and may have medical comorbidities that preclude open surgery. Balloon dilation for symptomatic treatment of these patients has been trialed, though with limited success.3 Another common approach is known as trans-oral stapled diverticulectomy. This has the drawbacks of poor visualization due to the large size of the stapler relative to the oral cavity, which can result in a residual pouch due to poor technique. Endoscopic cricopharyngeal myotomy offers lower rates of mortality and complications in the treatment of ZD. In conclusion, Z-POEM is an efficacious first-line treatment for ZD.
Related Knowledge Centers
- Mucous Membrane
- Pharynx
- Trachea
- Peristalsis
- Stomach
- Heart
- Larynx
- Thoracic Diaphragm
- Epiglottis
- Lumen