Esophagus

Corrosive Stricture esophagus

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Q) Which modality has no part in management of corrosive injury of esophagus? 

a) Repeated Endoscopies routinely

b) Esophagectomy in some cases

c) Early emergency surgery routinely

d) Steroid use routinely

Corrosive stricture esophagus mcqs

C

In corrosive injury of the esophagus, routine early emergency surgery is generally not indicated. The primary approach involves stabilization, assessing the extent of injury, and supportive care. Surgery is reserved for specific complications, such as perforation or severe necrosis.

Other than the need for emergency surgery for bleeding or perforation, elective oesophageal resection should be deferred for at least 3 months until the fibrotic phase has been established.

Oesophageal replacement is usually required for very long or multiple strictures. Resection can be difficult because of perioesophageal inflammation in these patients.

Regular endoscopic examinations are the best way to assess stricture development .

Significant stricture formation occurs in about 50% of patients with extensive mucosal damageo Corrosives can cause significant pharyngolaryngeal oedema

In unusual circumstances, e.g. with extensive necrosis after corrosive ingestion, emergency oesophagectomy may be necessary.

Questions on Esophagus 

Alkali and acidic injuries to the esophagus, both leading causes of corrosive stricture of the esophagus, differ in their effects due to distinct chemical reactions with tissue.

 Mechanism of Injury

  • Alkali Injuries: Ingested alkalis (e.g., drain cleaners) cause liquefactive necrosis, where tissue rapidly breaks down. This process allows alkalis to penetrate deep into the esophageal layers, often causing severe, widespread injury that extends to adjacent tissues. As a result, alkali injuries frequently lead to extensive scarring and stricture formation over time, significantly impacting the esophageal lumen.
  • Acidic Injuries: Acids like hydrochloric acid cause coagulative necrosis, resulting in protein denaturation and an eschar formation. This eschar limits acid penetration depth, typically causing more superficial injury compared to alkalis. However, mucosal damage can still be severe, leading to ulceration and potential esophageal stricture over time, especially if the injury affects the lower esophagus.

Pseudoachalasia

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Q) Most common cause of  pseudoachalasia is ?

(a) Benign tumors of esophagus

(b) Chagas disease

(c) Caustic injury

(d) Adenocarcinoma of cardia

d

Pseudoachalasia is an achalasia-like disorder that is usually produced by adenocarcinoma of the cardia

Other uncommon causes are

 1.benign tumours at this level.

2, Tumors of bronchus, pancreas

It  is a condition that mimics the symptoms of achalasia, but is caused by a different underlying problem. The most common cause  is  malignancy in the gastroesophageal junction (GEJ), which is the area where the esophagus meets the stomach. Other possible causes of pseudoachalasia include:

  • Esophageal stricture
  • Chagas disease
  • Radiation therapy to the chest
  • Aortic aneurysm
  • Thyroid cancer

Pseudoachalasia presents in an identical manner to idiopathic achalasia with progressive dysphagia to solids and liquids, retrosternal pain, regurgitation of undigested foods and weight loss.

The main difference between pseudoachalasia and achalasia is that it  is often associated with other symptoms, such as abdominal pain, vomiting, and weight loss.

The diagnosis is made through a combination of clinical evaluation, upper endoscopy, and esophageal manometry. Upper endoscopy can help to rule out a malignancy in the GEJ, and esophageal manometry can help to confirm the diagnosis of achalasia. In some cases, a CT scan or MRI of the chest may be needed to further evaluate the cause of pseudoachalasia.

Pseudoachalasia

Questions MCQs on Esophagus 

Case report 

Squamous cell cancer of upper esophagus

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Q) A 65-year-old male presents with grade IV dysphagia and is diagnosed with squamous cell carcinoma of the upper third of the esophagus. What is the most appropriate next step in management?

a) Definitive chemoradiotherapy
b) Neoadjuvant chemotherapy followed by transhiatal esophagectomy
c) Systemic chemotherapy alone
d) Neoadjuvant chemoradiotherapy followed by three-field esophagectomy

✅ Correct answer: a) Definitive chemoradiotherapy

💡 Explanation:

  • Upper third esophageal squamous cell carcinoma poses a challenge for surgical resection due to its proximity to the pharynx and larynx.

  • In resectable upper esophageal SCC, especially in older patients or when the tumor is very proximal, definitive chemoradiotherapy (CRT) is often the preferred treatment to avoid morbid surgery like laryngopharyngoesophagectomy.

  • Multiple guidelines, including NCCN and ESMO, recommend definitive CRT for upper esophageal SCC unless there’s a compelling reason for surgery.

❌ Why other options are incorrect:

  • b) Neoadjuvant chemo + THE:
      THE (transhiatal esophagectomy) is not suitable for upper esophageal tumors. It doesn't provide good access to cervical/upper thoracic esophagus.

  • c) Chemotherapy alone:
      Not standard. Chemotherapy without radiation is inadequate for curative intent in localized esophageal cancer.

  • d) Neoadjuvant CRT + three-field esophagectomy:
      Though this is an option for mid/lower third esophageal cancers, especially in younger patients, it's more morbid and rarely used for upper third SCC in older patients.

More MCQS

More Esophagus MCQS

Mock tests 

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Benign polyps of esophagus

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Q ) False regarding Benign lesion of esophagus

a) Fibrovascular  polyps are seen in mid and lower two third

b) Leiomyoma  and Leiomyosarcoma have same distribution.

c)Leiomyoma enucleation is sufficient

d) Leiomyoma are the most common benign tumors of esophagus

Ans- 

 

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PET scan in Ca esophagus

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Q1) False about role of PET scan in Ca esophagus

a) Upstages disease in 15% cases

b) Used to assess response to pre op chemo radiation

c) Used for selecting patients for surgery after neoadjuvant chemo Rt

d) Assessment of response is seen after 2 weeks of pre op chemo RT

Answer 

Esophagus

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Q ) Patient with normal swallowing but progressive poor peristalsis in lower 2/3rds of esophagus and reflux episodes.

a) Scleroderma

b) Achalasia

c) GERD
Answer

Gastric pullup

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Q 35) Not a step in Gastric pull up mobilization?

a) Lesser sac entering

b) Posterior mobilization of the duodenum

c) dilatation of hiatus

d) ligation of lesser curve vessels
Answer 35

Stomach is the best esophageal substitute. It has a single anastomosis, consistent blood supply and is durable

Disadvantage is reflux in the long term.

Check the answer to the question on gastric pull up in the answer

Caustic Injury to esophagus

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Q ) False regarding Caustic injury to Esophagus

a) Gastric lavage not done as it increases the chances of more injury

b) Neutralising  agents not given as it produces more injury than preventing it

c) Milk and albumin not given as it causes more damage

d) Activated charcoal not given as it doesn’t effectively absorb alkali

Check one more question on caustic injuries to esophagus here

Answer 

In  caustic injuries to the esophagus, early decisions have to be taken. The involvement of surgeon should be done early and patient should be placed under close monitoring.

Blind nasogastric and orogastric tubes should not be inserted and initially CT of chest and abdomen with contrast should be done to guide the subsequent procedures. Read on

 

Siewert

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  1. Q) False regarding CA Esophagus

    a) Siewert I treated as Esophageal cancer

    b) Siewert III treated as Gastric cancer

    c) Siewert II treated as Esophageal cancer or Merindino surgery

    d) Proximal margin in Esophagus is determined routinely to alter the management

    Answer