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The esophagus is a part of the alimentary tract. It is a muscular tube approximately 25 cm long extending from the pharynx to the stomach. The esophagus begins at the lower margin of the cricoid cartilage opposite the sixth cervical vertebra and enters the gastric orifice at the level of the twelfth thoracic vertebra.
To judge the anatomy, the function, as well as pathologic findings in the esophagus, contrast esophagographies are needed. Applied contrast media are the barium swallow and water soluble contrast media. For the diagnostic routine examination, viscous barium suspensions are required in order to judge motor disorders, the mucous membrane, and lateral boundaries. If perforation, rupture or postoperative...
Endoscopy is well established in the evaluation of esophageal disease. With the widespread availability of endoscopy in nearly every hospital around the world, it has largely supplanted radiological examination as the primary investigation of choice. The major advantage over radiological examination is that the endoscopist can directly visualize the mucosa and obtain targeted biopsy specimens. Furthermore,...
The primary goal of a preoperative risk analysis is the reduction of perioperative morbidity and mortality. The latter is still ranging up to 10% for esophageal cancer despite all progress in intensive care therapy and the refinement of surgical technique. The morbidity, in particular the incidence of pulmonary complications, is by far higher and amounts to approximately 50%.
Developments in surgical as well as anesthetic management have meant that the morbidity and the mortality of esophageal surgery have substantially reduced during the last decade. Modern anesthetic management allows targeted risk stratification, especially of cardiac and pulmonary risk factors, thus providing a rationale for intraoperative monitoring and choice of anesthetic technique as well as postoperative...
Gastroesophageal reflux disease is one of the most common diseases in western societies. The prevalence is estimated to be around 10% in those populations, if the presence of the disease is based on weekly or daily reflux symptoms [1–3]. The disease has been diagnosed more often due to increased and improved diagnostic activities, but there is also a true increase in incidence of the problem. Since...
In Western societies, gastroesophageal reflux has assumed importance for two reasons. First it is a common disorder with as many as 40% of the adult population having heartburn at least once a month and 7% experiencing it daily. Secondly, it is associated with adenocarcinoma of the cardia. Because the incidence of this is rising at a considerable rate (particularly in white Western males), cure of...
In esophageal carcinoma as well as in other malignant tumors, present-day oncology requires a standardized classification for planning treatment procedures, estimation of prognosis and evaluation of treatment results and, thus, quality assurance.
Throughout the last decades the results of surgical treatment on esophageal cancer have improved continuously. Before 1980 Isono [1] reported a 5-year survival rate of 12.4%. In this study he describes the mode of recurrence after esophagectomy: 13.0% of patients had local recurrence, 8.7% had recurrence in the residual esophagus, 43.5% had evidence of lymph node metastasis, 28.3% had recurrence in...
Despite new insights into its molecular basis and various treatment options evaluated in numerous trials, therapy of esophageal cancer remains a challenge. In the past, surgery was the only treatment option. A patient qualified for surgery when he presented in stable condition and when the tumor was believed to be resectable. Today a vast number of treatment strategies, including induction chemotherapy,...
Unlike some other malignancies, such as colon and breast carcinoma, recent progress in the management of esophageal carcinoma has been limited. The overall prognosis for this disease remains dismal, having improved only marginally over recent decades. Because most patients present with advanced stage carcinomas, treatment is usually palliative, and only a minority of patients are cured by surgery...
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