Esophagus

Autoimmune swallowing disorders

December 20, 2013     Mursalin M. Anis, MD, PhD; Ahmed M.S. Soliman, MD
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Lung herniation: An unusual cause of dysphagia

December 20, 2013     Karen Mason, MBBS, MRCS, FRCR; Richard D. Riordan, MBBS, BSC, MRCP, FRCR
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Abstract

Lung herniation is a rare condition that can be classified on the basis of location and etiology. We report an unusual case of right apical lung herniation presenting with dysphagia. Computed tomography of the neck demonstrated an air-containing structure in the root of the right side of the neck, related to but separate from the anteromedial aspect of the right lung apex. The diagnosis of an apical lung hernia was confirmed using high-resolution CT reconstructions. This case highlights that, although uncommon, apical lung hernias should always be considered when investigating abnormalities of swallowing. Identification of an apical lung hernia on plain chest radiographs avoids further unnecessary investigations and surgical intervention. Knowledge of their presentation may avoid complications that could arise from neck interventions such as subclavian central catheter insertion.

Esophageal perforation in a patient with diverticulum following anterior discectomy and fusion

October 23, 2013     Aasif A. Kazi, PharmD; Nancy L. Solowski, MD; Gregory N. Postma, MD; Paul M. Weinberger, MD
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 Most perforations are thought to result from esophageal retraction, direct injury during manipulation, hardware failure, or movement of cervical vertebral bodies during hyperextension.

Practical applications of in-office fiberoptic transnasal esophagoscopy in the initial evaluation of patients with squamous cell cancer of the head and neck

September 18, 2013     Robert W. Dolan, MD; Timothy D. Anderson, MD
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Abstract

We conducted a study to analyze the effectiveness of transnasal esophagoscopy (TNE) as an alternative to operative endoscopy (OE) for the evaluation of primary head and neck cancers and for the surveillance of synchronous esophageal cancers. Our study population was made up of 96 consecutively presenting patients-75 men and 21 women, aged 45 to 88 years (mean: 64)-who were treated at our institution for squamous cell cancer of the head and neck. Of this group, 42 patients had been evaluated with TNE and 54 with OE. More OEs were performed in patients with an unknown primary (26 vs. 3). Incidental findings on TNE included 3 cases of gastritis, 2 cases each of hiatal hernia and esophagitis, 1 case of Barrett esophagus, and 1 inlet patch. No incidental findings were reported during OE. Primary cancers were biopsied by TNE through a port on the endoscope in 4 patients; 2 of these cancers were in the tongue base, 1 in the hypopharynx, and 1 in the aryepiglottic fold. After the initial visit, patients in the TNE group waited significantly fewer days for their endoscopy than did those in the OE group (median: 6.5 vs. 16; p < 0.05). Conversely, patients in the OE group waited significantly fewer days for treatment following endoscopy (median: 12 vs. 20; p < 0.05). However, there was no significant difference between the TNE patients and the OE patients in the total number of days comprising their entire course of management, from the initial visit to definite treatment (median: 27.5 and 33 days, respectively; p = 0.7). We conclude that TNE is a reasonable alternative to OE for the initial screening for synchronous esophageal cancers in patients with squamous cancers of the head and neck. OE is preferred for the initial workup of unknown primary cancers and for large tongue base cancers. The rate of detection of clinically relevant incidental findings is higher with TNE. Biopsy is possible during TNE for all subsites within the upper aerodigestive tract.

Transnasal esophagoscopy and the diagnosis of a mediastinal foregut duplication cyst

August 21, 2013     Amarbir S. Gill, BS and Jennifer L. Long, MD, PhD
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Foregut duplication cysts are true mucus-filled cysts lined with a thin epithelial layer, arising from either bronchogenic, esophageal, or neuroenteric precursor tissue.

Systemic sclerosis and reflux

April 17, 2013     John J. Petronovich, BS; Jonathan M. Bock, MD
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MII-pH testing with impedance-based symptom association may improve diagnostic accuracy in patients with systemic sclerosis and reflux.

The missing tracheoesophageal puncture prosthesis: Evaluation and management

February 25, 2013     Shelby C. Leuin, MD; Daniel G. Deschler, MD
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Abstract

Placement of a tracheoesophageal puncture prosthesis in the post-laryngectomy patient has significantly improved voice rehabilitation in this population. Rarely, the prosthesis may become dislodged, necessitating medical evaluation. We present the case of a 61-year-old man who presented to our Emergency Department with a missing prosthesis. We describe the evaluation and management of this patient and review the relevant literature. We conclude with the following algorithm: When a patient presents with a missing prosthesis, evaluation of the tracheobronchial tree must be performed. Once the pulmonary system is cleared, the prosthesis can be presumed in the gastrointestinal tract and allowed to pass. A new prosthesis or catheter should be placed in the tract to prevent aspiration.

Esophageal graft-versus-host disease

February 25, 2013     Jeanne L. Hatcher, MD; S. Carter Wright, MD; Catherine Rees Lintzenich, MD, FACS
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Graft-versus-host disease occurs after allogeneic hematopoietic-cell transplantation, with the chronic form usually occurring within the first 3 years.

Massive Zenker diverticulum

August 10, 2012     Jonathan M. Bock, MD; John J. Petronovich, BS; Joel H. Blumin, MD
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Zenker diverticula rarely extend deep into the chest and induce severe dysphagia and aspiration pneumonia. In fact, only rare cases have been reported in the literature that exhibit such significant extension into the mediastinum.

Killian-Jamieson diverticulum

April 30, 2012     Ashli K. O'Rourke, MD; Paul M. Weinberger, MD; Gregory N. Postma, MD
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Killian-Jamieson diverticulum is generally smaller than Zenker diverticulum and is associated with less dysphagia, regurgitation, and gastroesophageal reflux.

Dilated esophagus and tracheal compression secondary to a slipped Nissen fundoplication: A case report

January 25, 2012     Roy Rajan, MD and Jerome W. Thompson, MD
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Abstract

We describe the case of a 20-month-old girl with a gastrostomy tube who presented with stridor, daily emesis, stertor, and mild neck retractions. Endoscopic and radiologic investigations revealed a dilated esophagus, an associated tracheal compression, and a paraesophageal hernia secondary to a slipped Nissen fundoplication. The patient underwent a revision fundoplication, and her stridor, stertor, and neck retractions subsided significantly. She tolerated tube feeding without emesis and was discharged home. We recommend a careful evaluation of fundoplication in patients who have undergone the procedure who present with stridor and frequent emesis. Esophageal dilation and associated tracheal compression should be considered in the differential diagnosis, and in such a case, revision of the gastric wrap should alleviate the problem.

Esophageal spasm

November 22, 2011     Ashli K. O'Rourke, MD, Paul M. Weinberger, MD, and Gregory N. Postma, MD
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