Esophageal Surgery

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Surgery for corrosive esophageal Injury

Caustic ingestion can cause severe injury to the esophagus and the stomach. The severity and extent of esophageal and gastric damage resulting from a caustic ingestion depend upon the following factors

  • Corrosive properties of the ingested substance
  • Amount, concentration, and physical form (solid or liquid) of the agent
  • Duration of contact with the mucosa

Most ingestion occurs in children and the remainder in psychotic, suicidal, and alcoholic subjects. More than 5000 caustic ingestions are reported annually in the United States; these ingestions are the leading cause of esophageal strictures in children

Children frequently expectorate most of the caustic agent before swallowing, thereby minimizing injury In comparison, suicidal patients often ingest larger amounts of caustic agents than those who accidentally swallow these agents; as a result, they are likely to have more severe esophageal and gastric damage. Prevention plays a key role in reducing the incidence of corrosive ingestion, especially in children, yet this goal is far from being reached in developing countries, where such injuries are largely unreported

Esophageal Cancer

Esophageal cancer is cancer that occurs in the esophagus — a long, hollow tube that runs from your throat to your stomach. Your esophagus carries food you swallow to your stomach to be digested.

Esophageal cancer usually begins in the cells that line the inside of the esophagus. Esophageal cancer can occur anywhere along the esophagus, but in people in the United States, it occurs most often in the lower portion of the esophagus. More men than women get esophageal cancer.


Signs and symptoms of esophageal cancer include:

  • Difficulty swallowing (dysphagia)
  • Weight loss without trying
  • Chest pain, pressure or burning
  • Fatigue
  • Frequent choking while eating
  • Indigestion or heartburn
  • Coughing or hoarseness

Early esophageal cancer typically causes no signs or symptoms.


It's not clear what causes esophageal cancer. Esophageal cancer occurs when cells in your esophagus develop errors (mutations) in their DNA. The errors make cells grow and divide out of control. The accumulating abnormal cells form a tumor in the esophagus that can grow to invade nearby structures and spread to other parts of the body.

Types of esophageal cancer

Esophageal cancer is classified according to the type of cells that are involved. The type of esophageal cancer you have helps determine your treatment options. Types of esophageal cancer include:

  • Adenocarcinoma. Adenocarcinoma begins in the cells of mucus-secreting glands in the esophagus. Adenocarcinoma occurs most often in the lower portion of the esophagus. Adenocarcinoma is the most common form of esophageal cancer in the United States, and it affects primarily white men.
  • Squamous cell carcinomaThe squamous cells are flat, thin cells that line the surface of the esophagus. Squamous cell carcinoma occurs most often in the middle of the esophagus. Squamous cell carcinoma is the most prevalent esophageal cancer worldwide.
  • Other rare typesRare forms of esophageal cancer include choriocarcinoma, lymphoma, melanoma, sarcoma and small cell cancer.

Risk Factors

It's thought that chronic irritation of your esophagus may contribute to the DNA changes that cause esophageal cancer. Factors that cause irritation in the cells of your esophagus and increase your risk of esophageal cancer include:

  • Drinking alcohol
  • Having bile reflux
  • Chewing tobacco
  • Having difficulty swallowing because of an esophageal sphincter that won't relax (achalasia)
  • Drinking very hot liquids
  • Eating few fruits and vegetables
  • Eating foods preserved in lye, such as lutefisk, a Nordic recipe made from whitefish, and some olive recipes
  • Having gastroesophageal reflux disease (GERD)
  • Being obese
  • Having precancerous changes in the cells of the esophagus (Barrett's esophagus)
  • Undergoing radiation treatment to the chest or upper abdomen
  • Smoking

Surgery for cancer of GE Junction

Cancer is a pervasive part of our society. It affects all ages and each generation has its unique experiences with this menace to our well being. Gastroesophageal cancer is a silent stalker here in the South.

More specifically, it is a cancer that develops at the junction between the esophagus, the tube that connects the stomach with the mouth, greater part of their lives and its onset is slow and insidious. Recent statistics and my and the stomach itself. It often preys on patients who use alcohol and tobacco for the own personal experience suggest that this disease may be becoming more ominous and more aggressive that historical controls would indicate.

A typical patient with cancer of the esophagus seeks medical attention because of symptoms of dysphagia or difficulty swallowing and weight loss. The patient maybe unable to swallow solid food but may do OK with liquids. Other patients may find the reverse to be true. Usually the patient feels that he or she is otherwise healthy and has no unusual risk factors or recent illnesses. The duration of symptoms is usually 1 to 6 months and most patients have no history of this type of problem in their family. All are convinced that a pill from their doctor will fix whatever is wrong with them and they will be free to resume their usual activities and bad habits quickly. What are the real facts?

It is well accepted by cancer researchers that cancer of the distal esophagus and proximal stomach (GE junction tumors) are the end result of a multistage process involving an "initiation stage" and a "promotion phase." The initiation phase begins when a carcinogen (an alkylating agent or chemical irritant) attacks the wall of the esophagus or stomach. This initial damaged area may heal on its own, or if not properly repaired, lead to changes in the underlying cell structure.

The promotion phase occurs as the injured cell structure begins to grow faster than the cells surrounding the damaged area. This early lesion is called an in situ tumor or early tumor localized to a very superficial area of tissue. The following sequence of events seems to follow: Normal tissue leads to hyperplasia or fast growth cell structure and this leads to dysplasia or abnormal cell structure. The next step is in situ or early invasive cancer followed by full blown invasive cancer and then lastly metastasis or spread to other parts of the body. Most cancers in this area historically grow from either the lining of the esophagus (squamous cell) or the lining of the stomach (adenocarcinoma). We are also beginning to see unusual variants of other cell lines all with similar clinical presentations.

Achalasia cardia

Achalasia is a rare disease of the muscle of the esophagus (swallowing tube). The term achalasia means "failure to relax" and refers to the inability of the lower esophageal sphincter (a ring of muscle situated between the lower esophagus and the stomach) to open and let food pass into the stomach. As a result, patients with achalasia have difficulty in swallowing food.

How does the normal esophagus function?

The esophagus has three functional parts. The uppermost part is the upper esophageal sphincter, a specialized ring of muscle that forms the upper end of the tubular esophagus and separates the esophagus from the throat. The upper sphincter remains closed most of the time to prevent food in the main part of the esophagus from backing up into the throat. The main part of the esophagus is referred to as the body of the esophagus, a long, muscular tube approximately 20 cm (8 in) in length. The third functional part of the esophagus is the lower esophageal sphincter, a ring of specialized esophageal muscle at the junction of the esophagus with the stomach. Like the upper sphincter, the lower sphincter remains closed most of the time to prevent food and acid from backing up into the body of the esophagus from the stomach.

The upper sphincter relaxes with swallowing to allow food and saliva to pass from the throat into the esophageal body. The muscle in the upper esophagus just below the upper sphincter then contracts, squeezing food and saliva further down into the esophageal body. The ring-like contraction of the muscle progresses down the body of the esophagus, propelling the food and saliva towards the stomach. (The progression of the muscular contraction through the esophageal body is referred to as a peristaltic wave.). By the time the peristaltic wave reaches the lower sphincter, the sphincter has opened, and the food passes into the stomach.

How does the normal esophagus function?

The most common symptom of achalasia is difficulty in swallowing (dysphagia). Patients typically describe food sticking in the chest after it is swallowed. Dysphagia occurs with both solid and liquid food. Moreover, the dysphagia is consistent, meaning that it occurs during virtually every meal.

Sometimes, patients will describe a heavy sensation in their chest after eating that may force them to stop eating. Occasionally, pain may be severe and mimic heart pain (angina). The cause of this discomfort is felt to be the accumulation of ingested food within the esophagus.

Regurgitation of food that is trapped in the esophagus can occur, especially when the esophagus is dilated. If the regurgitation happens at night while the patient is sleeping, food can enter the throat and cause coughing and choking. If the food enters the trachea (windpipe) and lung, it can lead to infection (aspiration pneumonia).

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