Response to chemotherapy in Carcinoma Esophagus

Q) A patient with carcinoma lower 1/3 of esophagus, receives chemo Radiotherapy and dysphagia shows complete response. What is the next step in management

a) Reassure

b) Follow with CT scan every  6 months 

c) Esophagectomy

d) EUS to look for residual disease

 Ans c

Clinical trials and meta‐analyses have shown that a CRT + surgery regimen could significantly improve the survival of locally advanced esophageal carcinoma patients compared to surgery alone

Endoscopic biopsy, endoscopic ultrasonography, MRI (at various sequences), and PET‐CT all had shortcomings for evaluating cCR and the therapeutic effect of nCRT. 


Caustic injury esophagus

Q)  True statement about caustic injury esophagus :

A. NG tube is inserted to allow enteral nutrition.

B. Gastric conduit is preferred for esophageal reconstruction

C. Early dilatation to prevent stricture formation is not recommended

D. Contrast esophagogram is performed in the initial 48 hours to characterise the extent of injury and detect perforation

Achalasia pressures

Q All are true about achalasia except

A. Type 1 Achalasia is characterised by 100% failed contractions (DCI<100) and no esophageal pressurisation

B. Type 3 Achalasia has premature contractions in atleast 20% swallows

C. IEM (Ineffective esophageal motility) is characterised by >20% ineffective swallows (DCI<450)

D. Patients with type 2 achalasia have the best response to therapy

Surgical Management of Zenker’s diverticulum

Q) What is not true about management of Zenker's diverticulum

a) Both endoscopic and surgical repair give equivalent results

b) In complete  diverticulectomy, myotomy is not necessary

c) If diverticulum is less than 2 cm, myotomy is sufficient

d) In   diverticulopexy suture the diverticulum to the posterior pharynx as opposed to the prevertebral fascia 

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