Esophagus

Black Esophagus

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Q) The black esophagus most commonly presents as

a) Chest pain

b) Hematemesis

c) Incidental

d) None

Caustic injury esophagus

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Q)  True statement about caustic injury esophagus :

A. NG tube is inserted to allow enteral nutrition.

B. Gastric conduit is preferred for esophageal reconstruction

C. Early dilatation to prevent stricture formation is not recommended

D. Contrast esophagogram is performed in the initial 48 hours to characterise the extent of injury and detect perforation

Achalasia pressures

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Q All are true about achalasia except

A. Type 1  Achalasia is characterized by 100% failed contractions (DCI<100) and no esophageal pressurisation

B. Type 3 Achalasia has premature contractions in at least 20% swallows

C. IEM (Ineffective esophageal motility) is characterized by >20% ineffective swallows (DCI<450)

D. Patients with type 2 achalasia have the best response to therapy

Surgical Management of Zenker’s diverticulum

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Q) What is not true about management of Zenker's diverticulum

a) Both endoscopic and surgical repair give equivalent results

b) In complete  diverticulectomy, myotomy is not necessary

c) If diverticulum is less than 2 cm, myotomy is sufficient

d) In   diverticulopexy suture the diverticulum to the posterior pharynx as opposed to the prevertebral fascia 

Similar Question on zenker's diverticulum here

 

 

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 

Esophagus Stricture

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Q ) To restore normal swallowing  esophagus stricture to be dilated at least?   
  (a) 30 mm 
  (b) 20 mm  
  (c) 16 mm   
  (d) 18 mm
Another Similar Question
Answer

 

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.

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