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Journal of Clinical Gastroenterology 2008The esophagus consists of 2 different parts. In humans, the cervical esophagus is composed of striated muscles and the thoracic esophagus is composed of phasic smooth... (Review)
Review
The esophagus consists of 2 different parts. In humans, the cervical esophagus is composed of striated muscles and the thoracic esophagus is composed of phasic smooth muscles. The striated muscle esophagus is innervated by the lower motor neurons and peristalsis in this segment is due to sequential activation of the motor neurons in the nucleus ambiguus. Both primary and secondary peristaltic contractions are centrally mediated. The smooth muscle of esophagus is phasic in nature and is innervated by intramural inhibitory (nitric oxide releasing) and excitatory (acetylcholine releasing) neurons that receive inputs from separate sets of preganglionic neurons located in the dorsal motor nucleus of vagus. The primary peristalsis in this segment involves both central and peripheral mechanisms. The primary peristalsis consists of inhibition (called deglutitive inhibition) followed by excitation. The secondary peristalsis is entirely due to peripheral mechanisms and also involves inhibition followed by excitation. The lower esophageal sphincter (LES) is characterized by tonic muscle that is different from the muscle of the esophageal body. The LES, like the esophageal body smooth muscle, is also innervated by the inhibitory and excitatory neurons. The LES maintains tonic closure because of its myogenic property. The LES tone is modulated by the inhibitory and the excitatory nerves. Inhibitory nerves mediate LES relaxation and the excitatory nerves mediate reflex contraction or rebound contraction of the LES. Clinical disorders of esophageal motility can be classified on the basis of disorders of the inhibitory and excitatory innervations and the smooth muscles.
Topics: Animals; Esophagus; Humans; Muscle Contraction; Muscle, Smooth; Peristalsis; Vagus Nerve
PubMed: 18364578
DOI: 10.1097/MCG.0b013e31816b444d -
Journal of B.U.ON. : Official Journal... 2017Esophageal cancer is one of the deadliest cancers due to its aggressive behavior and poor survival. It was mentioned in the works of ancient Chinese and Arabo-islamic...
Esophageal cancer is one of the deadliest cancers due to its aggressive behavior and poor survival. It was mentioned in the works of ancient Chinese and Arabo-islamic physicians, centuries before the recognition of high incidence in the Asian esophageal cancer belt. Till the 19th century the disease was considered incurable and the main goal of the proposed treatments was to alleviate dysphagia and pain. The introduction of esophagoscope in 1868 by Adolf Kussmaul (1822-1902) contributed to the observation of the living esophagus and to the diagnosis of esophageal pathologies, paving the way for new therapeutic approaches. In 1877, Vincenz Czerny (1842-1916) performed the first successful resection of the cervical esophagus for carcinoma, followed by Franz Torek (1861-1938) who carried out in 1913 the first successful subtotal thoracic esophagectomy and Tohru Ohsawa (1882-1984) who performed the world's first esophagectomy with an intrathoracic esophagogastric anastomosis. Nowadays, despite the advent of biomedical technology and the development of operation techniques, the surgical treatment of esophagus still remains a challenge.
Topics: Aged; Anastomosis, Surgical; Carcinoma, Squamous Cell; Deglutition Disorders; Esophageal Neoplasms; Esophagectomy; Esophagus; Female; History, 19th Century; History, 20th Century; Humans; Male; Middle Aged
PubMed: 28952239
DOI: No ID Found -
Digestive Surgery 2002Anastomotic complications after esophagectomy continue to be a burden jeopardizing the quality of life and of swallowing. However, incidence, mortality and morbidity of... (Review)
Review
Anastomotic complications after esophagectomy continue to be a burden jeopardizing the quality of life and of swallowing. However, incidence, mortality and morbidity of anastomotic complications have substantially decreased in recent years. It seems that this is not so much related to the use of a particular conduit, approach or route for reconstruction, but rather related to refinement in anastomotic techniques and perhaps even more to progress in modern perioperative management. Knowledge of surgical anatomy and meticulous technique are of paramount importance and obviously related to individual expertise. As to the management, most leaks can be treated by conservative measures and reintervention surgery today is rather exceptional. Early endoscopy and dilatation seem to decrease the incidence and severity of anastomotic stenosis.
Topics: Anastomosis, Surgical; Constriction, Pathologic; Esophageal Neoplasms; Esophagectomy; Esophagus; Humans; Plastic Surgery Procedures; Surgical Stapling; Suture Techniques
PubMed: 11978992
DOI: 10.1159/000052018 -
Der Chirurg; Zeitschrift Fur Alle... Jan 2019Endoscopic negative-pressure therapy (ENPT) is becoming a valuable tool in surgical complication management of transmural intestinal defects and wounds in the upper and... (Review)
Review
Endoscopic negative-pressure therapy (ENPT) is becoming a valuable tool in surgical complication management of transmural intestinal defects and wounds in the upper and lower gastrointestinal tract. Innovative materials for drains have been developed, endoscopic techniques adapted, and new indications for ENPT have been found. Based on our broad clinical experience, numerous tips and tricks are described, which contribute to the safety of dealing with the new therapy. The aim of this work is to present these methods. The focus is on describing the treatment in the esophagus.
Topics: Drainage; Endoscopy; Esophagus; Gastrointestinal Tract; Negative-Pressure Wound Therapy
PubMed: 30280205
DOI: 10.1007/s00104-018-0725-z -
World Journal of Gastroenterology Jul 2010Acute esophageal necrosis (AEN), commonly referred to as "black esophagus", is a rare clinical entity arising from a combination of ischemic insult seen in hemodynamic... (Review)
Review
Acute esophageal necrosis (AEN), commonly referred to as "black esophagus", is a rare clinical entity arising from a combination of ischemic insult seen in hemodynamic compromise and low-flow states, corrosive injury from gastric contents in the setting of esophago-gastroparesis and gastric outlet obstruction, and decreased function of mucosal barrier systems and reparative mechanisms present in malnourished and debilitated physical states. AEN may arise in the setting of multiorgan dysfunction, hypoperfusion, vasculopathy, sepsis, diabetic ketoacidosis, alcohol intoxication, gastric volvulus, traumatic transection of the thoracic aorta, thromboembolic phenomena, and malignancy. Clinical presentation is remarkable for upper gastrointestinal bleeding. Notable symptoms may include epigastric/abdominal pain, vomiting, dysphagia, fever, nausea, and syncope. Associated laboratory findings may reflect anemia and leukocytosis. The hallmark of this syndrome is the development of diffuse circumferential black mucosal discoloration in the distal esophagus that may extend proximally to involve variable length of the organ. Classic "black esophagus" abruptly stops at the gastroesophageal junction. Biopsy is recommended but not required for the diagnosis. Histologically, necrotic debris, absence of viable squamous epithelium, and necrosis of esophageal mucosa, with possible involvement of submucosa and muscularis propria, are present. Classification of the disease spectrum is best described by a staging system. Treatment is directed at correcting coexisting clinical conditions, restoring hemodynamic stability, nil-per-os restriction, supportive red blood cell transfusion, and intravenous acid suppression with proton pump inhibitors. Complications include perforation with mediastinal infection/abscess, esophageal stricture and stenosis, superinfection, and death. A high mortality of 32% seen in the setting of AEN syndrome is usually related to the underlying medical co-morbidities and diseases.
Topics: Acute Disease; Diagnosis, Differential; Esophageal Diseases; Esophagus; Gastric Outlet Obstruction; Humans; Ischemia; Necrosis; Prognosis; Syndrome
PubMed: 20614476
DOI: 10.3748/wjg.v16.i26.3219 -
BMC Cancer Sep 2021For patients with esophageal adenocarcinoma or cancer of the gastroesophageal junction, radical esophagectomy with 2-field lymphadenectomy is the cornerstone of the... (Randomized Controlled Trial)
Randomized Controlled Trial
Robot-assisted minimally invasive thoraco-laparoscopic esophagectomy versus minimally invasive esophagectomy for resectable esophageal adenocarcinoma, a randomized controlled trial (ROBOT-2 trial).
BACKGROUND
For patients with esophageal adenocarcinoma or cancer of the gastroesophageal junction, radical esophagectomy with 2-field lymphadenectomy is the cornerstone of the multimodality treatment with curative intent. Both conventional minimally invasive esophagectomy (MIE) and robot assisted minimally invasive esophagectomy (RAMIE) were shown to be superior compared to open transthoracic esophagectomy considering postoperative complications. However, no randomized comparison exists between MIE and RAMIE in the Western World for patients with esophageal adenocarcinoma.
METHODS
This is an investigator-initiated and investigator-driven multicenter randomized controlled parallel-group superiority trial. All adult patients (age ≥ 18 and ≤ 90 years) with histologically proven, surgically resectable (cT1-4a, N0-3, M0) esophageal adenocarcinoma of the intrathoracic esophagus or adenocarcinoma of the gastroesophageal junction and with European Clinical Oncology Group performance status 0, 1 or 2 will be assessed for eligibility and included after obtaining informed consent. Patients (n = 218) with resectable esophageal adenocarcinoma of the intrathoracic esophagus or adenocarcinoma of the gastroesophageal junction are randomized to either RAMIE (n = 109) or MIE (n = 109). The primary outcome of this study is the total number of resected abdominal and mediastinal lymph nodes specified per lymph node station.
CONCLUSION
This is the first randomized controlled trial designed to compare RAMIE to MIE as surgical treatment for resectable esophageal adenocarcinoma or adenocarcinoma of the gastroesophageal junction in the Western World. The hypothesis of the proposed study is that RAMIE will result in a higher abdominal and mediastinal lymph node yield specified per station compared to conventional MIE. Short-term results and the primary endpoint (total number of resected abdominal and mediastinal lymph nodes per lymph node station) will be analyzed and published after discharge of the last randomized patient within this trial.
TRIAL REGISTRATION
ClinicalTrials.gov Identifier: NCT04306458 . Registered 13th March 2020, https://clinicaltrials.gov/ct2/show/NCT04306458; Date of first enrolment 18.01.2021; Target sample size 218; Recruitment status: Recruiting; Protocol version 2; Issue date 10.03.2020; Rev. 02.02.2021; Authors ET, PCvdS, PPG.
Topics: Abdomen; Adenocarcinoma; Adult; Aged; Aged, 80 and over; Esophageal Neoplasms; Esophagectomy; Esophagogastric Junction; Female; Germany; Humans; Laparoscopy; Lymph Node Excision; Male; Mediastinum; Middle Aged; Robotic Surgical Procedures; Thoracoscopy
PubMed: 34565343
DOI: 10.1186/s12885-021-08780-x -
Computational and Mathematical Methods... 2021In order to investigate the diagnostic value of prenatal ultrasound parameters and signs of pouch and lower thoracic esophagus in the fetus with esophageal atresia (EA),...
In order to investigate the diagnostic value of prenatal ultrasound parameters and signs of pouch and lower thoracic esophagus in the fetus with esophageal atresia (EA), the prenatal ultrasound data of 35 EA fetuses (observation group) confirmed by autopsy after induced labor or postnatal surgery and imaging examination in our hospital from May 2019 to May 2021 were retrospectively analyzed and compared with 35 normal postnatal fetuses (control group). General information and prenatal ultrasound parameters of the two groups, including head circumference (HC), abdominal circumference (AC), double parietal diameter (BPD), fetal body weight (EFW), and signs (small or unmanifested gastric vesicles, amniotic fluid, neck or upper chest pouch, lower chest esophagus not visible), were analyzed using logistic regression. The logistic multifactor regression model for EA diagnosis was established, and the diagnostic value for EA was analyzed. As a result, the HC, AC, and EFW of the observation group were lower than those of the control group, the gastric bubbles were small or not displayed, the amniotic fluid was more, and the signs of neck or upper chest pouch and lower chest esophagus were not visible in the observation group ( < 0.05). Logistic regression analysis showed that decreased ultrasound parameters HC, AC, EFW, small or no gastric bubble, amniotic fluid, neck or upper chest pouch, and no visible signs of lower chest esophagus were all risk factors for EA ( < 0.05). And in the prenatal ultrasound diagnostic model of EA was established, logistic () = -19.851 + HC × 0.384 + AC × 0.682 + EFW × 0.695 + small or no gastric vesicle × 3.747 + amniotic fluid × 3.607 + cervical or upper chest sac × 4.104 + invisible lower thoracic esophagus × 4.623.When logistic () > 0.468, AUC was 0.891, 2 was 7.764, diagnostic sensitivity was 91.24%, and specificity was 79.22%. To draw a conclusion, prenatal ultrasound parameters and signs are of great value in the diagnosis of EA. Independent influencing factors of EA include small or no HC, AC, EFW and gastric vesicles, polyhydramnios, neck or upper chest pouch, and invisible lower thoracic esophagus. Logistic multifactor regression model has a high coincidence rate for the prenatal diagnosis of EA, providing a basis for clinical decision-making.
Topics: Adult; Case-Control Studies; Computational Biology; Esophageal Atresia; Esophagus; Female; Gestational Age; Humans; Image Interpretation, Computer-Assisted; Logistic Models; Multivariate Analysis; Pregnancy; Retrospective Studies; Ultrasonography, Prenatal
PubMed: 34976113
DOI: 10.1155/2021/8107461 -
Acta Cirurgica Brasileira 2009To evaluate a technique to remove the thoracic esophagus without thoracotomy and two methods for thoracic esophageal replacement in dogs.
PURPOSE
To evaluate a technique to remove the thoracic esophagus without thoracotomy and two methods for thoracic esophageal replacement in dogs.
METHODS
27 ex-vivo dogs were divided into three groups in order to evaluate: G1 - total thoracic esophagectomy by the everting stripping method; G2 - total thoracic esophagectomy and esophageal substitution using the whole stomach; G3 - total thoracic esophagectomy and esophageal substitution using fundus rotation gastroplasty. After esophageal resection in G1, the integrity of the intrathoracic route was evaluated by endoscopy and tested with 1% methylene blue solution.
RESULTS
Visceral pleural rupture was observed in all animals. However, this intrathoracic route made it possible to bring both esophagus substitutes (G2 and G3) to be anastomosed to the cut end of the cervical esophagus.
CONCLUSIONS
Thoracic esophageal substitution using the whole stomach showed less anastomotic tension and was less technically demanding than the fundus rotation gastroplasty method. The ex-vivo results support further studies to validate the techniques in clinical cases.
Topics: Animals; Dog Diseases; Dogs; Esophagectomy; Esophagogastric Junction; Esophagus; Female; Gastroplasty; Ligation; Male; Stomach
PubMed: 19851687
DOI: 10.1590/s0102-86502009000500004 -
The Journal of Thoracic and... Dec 2020At least partially technically related, a cervical esophagogastric anastomosis has a 12% to 14% leak rate, which is theoretically reducible with simulator practice....
OBJECTIVES
At least partially technically related, a cervical esophagogastric anastomosis has a 12% to 14% leak rate, which is theoretically reducible with simulator practice. Preliminary development and testing of a cervical esophagogastric anastomosis simulator are described.
METHODS
A portable, low-cost, scale reproduction of the cervical esophagogastric anastomosis operative site was engineered around a 19 × 11 × 6-cm plastic box. Silicone "esophageal" and "gastric tip" castings permitted construction of a stapled side-to-side cervical esophagogastric anastomosis guided by an illustrated curriculum. In a 2-phase pilot study, the simulator and curriculum were evaluated. Phase 1: Seven faculty evaluated fidelity using a 5-point, 24-item survey of (1) physical attributes, (2) realism of materials, (3) realism of experience, (4) value, and (5) relevance, and (6) ability to perform tasks. Overall impression of the simulator was also measured. Phase 2: Eight thoracic surgical trainees similarly evaluated the simulator and the quality of the curriculum. Faculty and trainee ratings were compared using a Rasch model, and inter-rater agreement was estimated.
RESULTS
There were no overall fidelity differences across faculty and resident ratings. Combined observed averages ranged from 4.52 (Realism of Materials) to 5.00 (Relevance). Lifelike feel of esophagus had the lowest ratings (observed average = 4.40). Residents rated interrupted outer layer of anterior closure to be more difficult (observed average = 4.13) than faculty (observed average = 4.86; P = .016, d = 1.99). Global ratings (observed average = 3.33/4.00) indicated participants believed the simulator could be used for cervical esophagogastric anastomosis training now, but could be improved slightly.
CONCLUSIONS
Preliminary evidence suggests the novel cervical esophagogastric anastomosis simulator is valuable as a surgical training tool.
Topics: Anastomosis, Surgical; Clinical Competence; Curriculum; Digestive System Surgical Procedures; Education, Medical, Graduate; Esophagus; Humans; Simulation Training; Stomach; Thoracoscopy
PubMed: 32305201
DOI: 10.1016/j.jtcvs.2020.02.099 -
California Medicine May 1959Mediastinal emphysema may occur due to migration of air from the lungs, from the esophagus or tracheobronchial tree and from the abdomen. Of especial interest is the...
Mediastinal emphysema may occur due to migration of air from the lungs, from the esophagus or tracheobronchial tree and from the abdomen. Of especial interest is the mechanism starting with the rupture of the perivascular alveoli due to a rapid decrease in intrathoracic pressure from any cause, the development of pulmonary interstitial emphysema and migration of the air into the mediastinum. In one case the patient had severe interstitial emphysema of the left lung, mediastinal emphysema and subcutaneous emphysema without pneumothorax and rapid improvement followed tracheotomy. In another case the patient had interstitial emphysema of the left lung that did not progress to mediastinal emphysema and subcutaneous emphysema. Pneumothorax was not present. Recovery was more rapid than in the first patient.
Topics: Abdominal Cavity; Esophagus; Humans; Lung; Mediastinal Emphysema; Mediastinum; Medical Records; Pneumothorax; Pressure; Pulmonary Alveoli; Pulmonary Emphysema; Rupture; Subcutaneous Emphysema; Thorax; Tracheotomy; Viscera
PubMed: 13651959
DOI: No ID Found