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Esophagus MCQ      Achalasia Cardia                      Questions 11-15

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Q6. Greatest inaccuracy regarding T stage for Carcinoma esophagus in EUS is for
a) T1 tumor
b) T2 tumor
c) T3 tumor
d) T4 tumor
Q7.  A patient presents with GERD and on investigation has a stricture at lower end of esophagus. Which of the following is the poorest surgical repair in him
a) Total fundoplication
b) Partial fundoplication
c) Lengthening gastroplasty with partial fundoplication
d) Lengthening gastroplasty with total fundoplication
 Q8.  Management of Plummer Vinson syndrome
a) Esophagostomy
b) Esophagectomy
c) Dilatation of esophageal web and Iron therapy
d) Hydroocortisone injection

Q9. All are premalignant for carcinoma esophagus except

a) Diverticulum                                                       b) Caustic burn
c) Mediastinal fibrosis                                        d) Human papillloma virus
Q10. Most important prognostic factor for carcinoma esophagus is
a) cellular differentiation                                 b) Depth of  esophagus involvement
c) length of  esophagus involvement            d)   age of the patient



6 b

EUS is better than CT or any other diagnostic modality for diagnosis of carcinoma esophagus. C T scan only shows thickened esophagus wall in cases of carcinoma esophagus which is not specific for malignancy and also can not truly describe the extent of local disease.

The greatest inaccuracy of EUS in reporting the local extent for Ca esophagus is for T2 tumors. This is because for clinical assessment the fourth ultrasound layer is interpreted as the muscularis propria. This layer, however, does not include the interface between the submucosa and muscularis propria; it is contained in the third ultrasound layer. Thus, the border necessary to completely differentiate T1 from T2 tumors is contained in the third ultrasound layer. As two boundaries must be assessed for determination of T2 and errors might occur at each, the inaccuracy is potentially twice that of T1 and T4 tumors.

Ref Shakelford 6th edition , Chapter Endoscopic Esophageal Ultrasonography


7 b Partial fundoplication

Stricture and GERD are associated with shortening of esophagus and not enough length is available for intragastric pulling of esophagus. A tension free repair is unlikely with partial fundoplication and failure rate of such an operation can be as high as 40%. Dilatation of the stricture and total fundoplication gives good results, so does lengthening gastroplasty.

Total Fundoplication - 360 degree wrap

8  C                Dilatation with Iron therapy

Plummer Vinson syndrome is common in women characterized by upper esophageal web. It is also known as  siderop

It is associated with spoon shaped nails, iron deficiency anemia and atrophic oral mucosa.

It also predisposes to Ca esophagus

Spoon nails


9) c
Risk factors for carcinoma  of esophagus are Alcohol, tobacco, beverages( low), nitrosamines, polycyclic aromatic hydrocarbons, croton flaveus, trace element deficiencies
Tylosis, achlasia (midesophagus), strictures due to lye ingestion,  chronic esophagitis are other risk factors.
Barrets esophagus, congenital rests of columnar epithelium predispose to carcinoma esophagus and particularly adeno carcinoma.
Diverticula have a very small risk of carcinoma, HPV 16 and HPV 18 lead to carcinoma esophagus.
schakelford  5th edition, page 356
Most important is depth of involvement of wall  of esophagus and lymph node involvement of the surrounding esophageal tissue.
Length of esophagus involvement is not that important because esophagus has extensive submucosal lymph supply and for complete cure 10 cm excision margin would mean removal of almost total esophagus.