Esophagus

Siewert classification for GE junction tumors

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Q) According to Siewert classification tumors at GE junction are

a) Type I

b) Type II

c) Type III

d) Type IV

Answer b

Type I   Lower  (center located within between 1-5cm above the anatomic OGJ)

Type II Real GE junction  (within 1cm above and 2cm below the OGJ)

Type III  (2-5cm below OGJ)

This classification has only 3 subtypes

According to the Siewert-Stein classification,

Type I tumour 25% approx

Type II - Most common 49%

Type III was present in 25%

This classification helps in deciding the operative management and unified pre op classification

Types of Surgery

Type I cancer--depending of the size of the tumour--distal 2/3 oesophagectomy with the resection of the proximal lesser curve of the stomach or total gastrectomy  or THE

In patients with types II and III cancers total gastrectomy

More ref 

  1. Radiopedia
  2. Reviews Article

 

Timing after esophagus perforation

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Q) Management of esophagus perforation after 96  hours in a 40 year old patient with pulse 110/min and BP 110/80 Best option

a) Antibiotics and drainage of left pleural effusion

b) Primary repair of esophagus

c) Esophagectomy and gastric pull up

d) Cervical Esophagus diversion 

Questions on Esophagus

Discussion on all treatment modalities and which to use when

 

Esophagus perforation

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Q) A 45 year old man who has been drinking regularly for the past 15 years vomits after a large meal and complains of severe chest pain. Cardiac cause is ruled out and boerhavve's syndrome is suspected. Which of the following is not true about this condition

a) Gastrograffin tests will confirm the diagnosis

b) Perforation is most common in the left lower end

c) Exploration and full thickness suturing of perforation should be done

d) This condition has a high morbidity and mortality if not diagnosed at time

Answer for premium members  - Discussion on Boerhaave's syndrome

Barrett esophagus

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Q . Barrett's esophagus is a premalignant condition. Which of  the following statement is false regarding Barrett's esophagus

 a) Barrett's mucosa predisposes to Squamous cell carcinoma of esophagus

b) Risk of Cancer is 0.5% per year

c) Prevalence of Barrett's esophagus in general  population is  2-7%

d) Intestinal type of mucosa  with goblet cells is the most  common histopathological finding

Answer for Premium members

Caustic injuries to esophagus

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Q) Which of the following is not true about reconstruction in caustic injuries to esophagus

a) Caustic injuries to esophagus have 1000 times more risk of developing malignancy

b) Right colon replacement is definately better than left colon

c) The only indication for elective surgery is refractory strictures and possibility of malignancy

d) Most of the surgeons prefer bypass over resection of esophagus

Premium Answer

Conduits of Esophagus

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Q) What is true regarding gastric conduits to be used as esophagus replacement?

a) The right gastric and gastro epiploic arteries can be safely divided to bring stomach to the neck

b) For malignant diseases stomach is the most reliable conduit

c) Stomach has the least incidence of developing reflux esophagitis

d) For benign esophageal strictures stomach is the conduit of choice

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