Perforation of the esophagus
Larry R. Kaiser, Sarah K. Thompson, Glyn G. Jamieson in Operative Thoracic Surgery, 2017
Underlying esophageal disease plays a critical role in determining the kind of procedure to be performed. As perforation occurs most commonly during dilatation of strictures, and because the mechanism of injury is such that the wall of the esophagus is injured at or just above the stric- ture, therapy should be planned accordingly. If the stricture is chronic, fibrotic, and recalcitrant to previous dilations, the best treatment is to resect the stricture and perforated area, and immediately reconstruct the gastrointestinal tract. If the perforation is caused by dilatation for achalasia, closure of the perforation and a Heller myotomy on the other side of the esophagus are recommended. Likewise, if an early stage or locally advanced esophageal cancer is perforated and promptly identified, immediate esophagectomy and primary reconstruction should be considered if the patient is a candi- date for esophagectomy. Whatever the choice, the key surgical principle is to never close primarily a perforation above an esophageal obstruction.
Muscle Disorders
Philip B. Gorelick, Fernando D. Testai, Graeme J. Hankey, Joanna M. Wardlaw in Hankey's Clinical Neurology, 2020
Esophageal disease, manifested by dysphagia, occurs in about 15–50% of patients. There are two main forms: Proximal dysphagia is caused by involvement of striated muscle of the pharynx or proximal esophagus, correlates with severity of the muscle disease, and responds to steroid treatment.Distal dysphagia is due to involvement of nonstriated muscle and is more common in patients who have an overlap with scleroderma or another collagen–vascular disorder.
Complications of Esophageal Surgery and Trauma
Stephen M. Cohn, Matthew O. Dolich in Complications in Surgery and Trauma, 2014
Most perforations of the esophagus are iatrogenic, occurring during diagnostic and therapeutic endoscopic procedures. Successful management depends on four main factors: (1) age and overall condition of the patient, (2) cause and location of the perforation, (3) time interval between diagnosis and treatment, and (4) presence of any underlying esophageal disease.
Serial Endoscopic Evaluation of Esophageal Disease in a Cancer Model: A Paradigm Shift for Esophageal Adenocarcinoma (EAC) Drug Discovery and Development
Published in Cancer Investigation, 2018
Ashten N. Omstead, Juliann E. Kosovec, Daisuke Matsui, Samantha A. Martin, Matthew A. Smith, D. Aaron Guel, Jenna Kolano, Yoshihiro Komatsu, Fahim Habib, Christopher Lai, Kevi Christopher, Ronan J. Kelly, Ali H. Zaidi, Blair A. Jobe
Endoscopic evaluation with biopsy of suspicious lesions was performed on all animals immediately prior to euthanasia (Figure 1). Food and water were restricted from animals for 2–6 h prior to endoscopic evaluation and for 2–4 h post-procedure. Rats were anesthetized with isofluorane at 5% and 2% induction and maintenance, respectively. Animals were intubated using an adjusted 16-gauge intravenous catheter to allow for mechanical ventilation and administration of inhaled anesthesia during endoscopy and were positioned supine on a circulating water-heated surgical bed to maintain body temperature. Visual endoscopic evaluation was performed of entire esophagus using a rigid Karl Storz endoscope (diameter 1.9/2.1 mm) as previously described (27). Biopsies were obtained with 1-mm pinch miniature biopsy forceps with double-action jaws (Karl Storz, Tuttlingen, Germany). Air was introduced through side port of endoscope to aid visualization of distal esophagus. The highest level of esophageal disease observed on endoscopy was biopsied, and if there was no abnormal lesion present, the area approximately 2 mm proximal to the esophagojejunostomy was biopsied. Two biopsies were obtained, approximately 2 mm in size, during the course of each endoscopy for histological analysis. All endoscopic evaluations were recorded using a digital video recorder (AIDA HD Connect DVD, Karl Storz, Tuttlingen, Germany) and were completed within 10 min.
Screening children for eosinophilic esophagitis: allergic and other risk factors
Published in Expert Review of Clinical Immunology, 2019
Melanie A. Ruffner, Peter Capucilli, David A. Hill, Jonathan M. Spergel
In addition, we observed a higher prevalence of Autism Spectrum Disorder (ASD) within our cohort of EoE patients; the rate of ASD in children with EoE is 7.5%, compared to 1.9% in those without EoE (OR 4.2, 95% CI 2.9–6.0, P < 0.0001) [9]. While the etiology of this relationship remains unknown, the often-severe adverse feeding behaviors that can be characteristic of ASD may in part be due to underlying and potentially undiagnosed esophageal disease. These findings support a recommendation screen for EoE in patients with ASD, and unexplained feeding dysfunction and highlight a potential role for nutritionists and occupational therapists in screening for EoE. These specialists can play a pivotal role in recognizing when abnormal feeding behaviors may be indicative of esophageal or other GI dysfunction. Future research efforts are needed to verify the extent of this association on a population scale. Delineating specific symptoms indicative of EoE as opposed to a behavioral feeding disorder in ASD will be paramount to providing more specific evidence-based clinical recommendations.
Immune surveillance activation after neoadjuvant therapy for esophageal adenocarcinoma and complete response
Published in OncoImmunology, 2020
Andromachi Kotsafti, Melania Scarpa, Francesco Cavallin, Matteo Fassan, Roberta Salmaso, Andrea Porzionato, Luca Saadeh, Matteo Cagol, Rita Alfieri, Carlo Castoro, Massimo Rugge, Ignazio Castagliuolo, Marco Scarpa
Esophageal adenocarcinoma (EAC) is an increasingly common cancer with a poor prognosis. This mainly depends on the fact that most patients present with locally advanced or widespread metastatic disease. Combined modality treatment protocols such as neoadjuvant radiation and/or chemotherapy (CTRT) followed by surgery represent the current treatment option.1,2 Neoadjuvant chemoradiotherapy is commonly proposed to downstage the tumor and enhance the R0 resection rate.3,4 In fact, neoadjuvant therapy can effectively downstage cancer in patients with locally advanced esophageal disease, 5,6 and prolonged survival has been observed in patients with a pathological complete response (pCR).7,8 In the CROSS trial, preoperative chemoradiotherapy improved survival among patients with potentially curable esophageal or esophagogastric-junction cancer with acceptable adverse-event rates.9 In this study, pCR rate was 29% in the group of patients who underwent resection after chemoradiotherapy.9
Related Knowledge Centers
- Gastroesophageal Reflux Disease
- Esophagus
- Barrett'S Esophagus
- Globus Pharyngis
- Esophageal Achalasia
- Acute Esophageal Necrosis
- Esophageal Rupture
- Chemical Burn
- Chagas Disease
- Diffuse Esophageal Spasm