Esophagus

EUS in carcinoma esophagus

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Esophageal Wall Layers EUS MCQ | mcqsurgery.com
Q) A 60-year-old patient undergoes EUS for staging of an early esophageal tumor. Regarding the echogenic layers of the esophageal wall, which of the following statements is INCORRECT?
✅ Answer: c) The fourth hyperechoic layer represents the muscularis propria (incorrect — the fourth layer is hypoechoic and corresponds to muscularis propria).

🔍 Explanation:
EUS shows 5 layers of the esophageal wall:
  • 1. Hyperechoic – superficial mucosa/water interface
  • 2. Hypoechoic – deep mucosa
  • 3. Hyperechoic – submucosa
  • 4. Hypoechoic – muscularis propria
  • 5. Hyperechoic – adventitia
Correct identification is critical for T-staging of esophageal cancer. Misidentifying layer 4 may lead to incorrect staging and management errors. Radial echoendoscopes provide optimal visualization of all layers.
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Esophagectomy Chyle leak

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Premium MCQ - Chylothorax Management after Esophagectomy
Q) A 66-year-old male undergoes TTE. After esophagectomy, ICD output is 1000 ml chyle on 5th postoperative day. What should be the next step in management?
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Ivor Lewis Esophagectomy leak

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Q) After Ivor Lewis esophagectomy, on postoperative day 5 (POD 5), bile is seen in the chest tube.

The patient presents with a heart rate of 120 bpm, a temperature of 101°F, and blood pressure of 100/70 mmHg. What is the next appropriate step in management?

  • a) Stenting
  • b) Colonic replacement of gastric conduit
  • c) IV antibiotics
  • d) Conduit excision and esophageal diversion
Correct Answer: d) Conduit excision and esophageal diversion

In patients who develop a completely necrotic conduit post-esophagectomy, the risk of sepsis is high. These patients often require urgent surgical intervention. Upon confirming conduit necrosis, the conduit must be resected, and the patient should undergo diversion, which includes:

  • End esophagostomy
  • Venting gastrostomy
  • Feeding jejunostomy

It is crucial to maintain as much length of the remaining esophagus as possible to facilitate future reconstructive procedures.

Key Points:

  • Postoperative Day 5: Critical time for monitoring complications after esophagectomy.
  • Symptoms of Concern: Tachycardia, fever, and hypotension may indicate sepsis or other complications.
  • Surgical Intervention: Timely recognition and management are vital for patient outcomes.

For further reading, refer to Schakelford’s Surgical Anatomy of the Gastrointestinal Tract, page 477.

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THE vs TTE

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Esophagus Surgery
Esophagus Mock Test 1
Q) Trans Hiatal Esophagectomy (THE) vs Trans Thoracic Esophagectomy (TTE) – which is not true?
(Question asked in all AIIMS and INI exams since 2017)
a) Leak rates are more with TTE
b) Pulmonary complication is more with TTE
c) Side to side stapler anastomosis has less leaks than open two layer suturing
d) THE can be done through minimally invasive surgery
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Caustic Injuries of Esophagus

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Q . Caustic injury of esophagus. Which statement is not true  ( # All Questions of esophagus) 
a) Steroid is used as a treatment 
b) Carcinoma risk  is 30%
c) Contrast study has false negative of 25%
d Esophageal stent reduce leaks by 75%

Ans ) a

Points of esophagus caustic injuries

There is no proven benefit of starting steroids in early or intermediate phase of injury as there is no evidence to support prevention of stricture

  1. Endoscopy should be performed after initial stabilization
  2. Complete esophagus can be examined now with flexible endoscopes
  3. Available studies show no benefit of steroid use ( skf PAGE 521) 
  4. Cancer risk is 30% in injured and non injured portions

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