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Q6. Greatest inaccuracy regarding T stage for Carcinoma esophagus in EUS is for
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
Q9. All are premalignant for carcinoma esophagus except
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.
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