• Postprandial emesis suggests lower esophageal disease.
  • Pain, Emesis, Weight Loss - Think
    • Ulcers
    • Neoplastic Procss
  On Exam: 
  • Can look for palpable masses/lymph nodes
  • Succussion Splash- Sloshing sound heard on auscultation of stomach when pt. is rocked back and forth at the hips- often suggests gastric outlet obstruction or gastroparesis. One small study found ~1/3 of pts. with GOO to have + succussion splash. 
  
  

  Posted 01/04/17 11:09:39 AM by Adam Faye

• UGI Series: Drink barium contrast and multiple radiographs taken to see how contrast moves through esophagus and stomach
  • Masses such as carcinoma usually fungate - so appearance of contrast does NOT look smooth
  • Achalasia- Smooth tapering down to LES; usually dilated proximal esophagus with absence of contractions seen on UGI series
  
  Endoscopy
  • Carcinomas - Difficult to pass endoscope across
  • Achalasia - Easy to push through with endoscope
  
  

  Posted 01/04/17 11:14:18 AM by Adam Faye

• Short-Segment Barrett's:
  • < 3cm segment
  • Does not increase risk for malignancy
  • Lesion length correlated with malignancy risk; also recent data suggesting that BE segments do not change much in length over time
  
  

  Posted 01/04/17 11:21:24 AM by Adam Faye

• Esophageal Carcinoma: Two main subtypes of esophageal carcinoma
  
  
  Squamous Cell Carcinoma (precursor: squamous dysplasia)
  • 90% of cases world-wide
  • Predominant type in Asia, South America, Africa
  • Risk factors: Tobacco, Alcohol
  • Location: Proximal – middle esophagus
  Adenocarcinoma (precursor: Barrett’s esophagus)
  • Increasing prevalence in North America, Europe
  • Risk factors: GERD, obesity, tobacco
  • Location: Distal esophagus 
  
  

  Posted 01/04/17 11:23:17 AM by Adam Faye

• Esophageal SCC Treatment: Standard is concurrent radiation + chemotherapy
  
  
  Radiation
  • Disease control v palliation
  • Poor survival rates w radiation alone
  Chemotherapy
  • No standard regimen (typically FU + cisplatin v paclitaxel + carboplatin)
  Palliation
  • Radiation v stents for dysphagia 
  
  

  Posted 01/04/17 11:25:25 AM by Adam Faye

Created by Christopher Kelly

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