PS01.109: A RARE TUMOR OF THE CERVICAL ESOPHAGUS: SCHWANNOMA

2018 ◽  
Vol 31 (Supplement_1) ◽  
pp. 80-81
Author(s):  
Yener Aydin ◽  
Atila Eroglu ◽  
Ali Ulas ◽  
Hilmi Keskin ◽  
Sevilay Ozmen
Keyword(s):  
Conflicts Of Interest ◽  
Frozen Section ◽  
Muscularis Propria ◽  
Cervical Esophagus ◽  
Proximal Esophagus ◽  
Absorbable Sutures ◽  
Cervical Incision ◽  
Esophageal Tumors ◽  
Oral Diet ◽  
Esophageal Muscle

Abstract Background Schwannomas esophagus is very rarely seen. In this study, a schwannoma case with cervical esophagus was presented. Methods A 26-year-old female presented with dysphagia. In esophageal ultrasonography, a homogeneous, hypoechoic, and smooth-sided lesion originating from the proximal esophagus muscularis propria was detected. MRI revealed a well-defined mass lesion located in the cervical esophagus. Results The left cervical incision was performed and the lesion was enucleated. After the enucleation, saline was inserted into the enucleated area, and air was injected into the nasogastric tube to investigate the possibility of mucosal injuries. The esophageal muscle layers were then primarily closed with absorbable sutures. Frozen section examination was benign. Postoperative histopathological evaluation was assessed as accordance with schwannoma (Figure). Oral diet was started on the 3th postoperative day. There were no complications postoperatively. The patient was discharged on the 5th postoperative day. Conclusion The vast majority of esophageal tumors are cancer. Benign esophagial tumors constitute less than 1% of all esophageal tumors. Approximately 80% of benign esophagus tumors are leiomyomas. Esophageal schwannoma is very rare and difficult to diagnose by endoscopy and imaging methods. In these cases, surgery provides both definitive diagnosis and treatment. Disclosure All authors have declared no conflicts of interest.

Antioxidant enzymes in intramural nerves of the opossum esophagus

1996 ◽  
Vol 270 (1) ◽  
pp. G136-G142 ◽  
Author(s):  
R. M. Thomas ◽  
S. Fang ◽  
L. S. Leichus ◽  
L. W. Oberley ◽  
J. Christensen ◽  
...  
Keyword(s):  
Nitric Oxide ◽  
Superoxide Dismutase ◽  
Antioxidant Enzymes ◽  
Superoxide Radical ◽  
Muscularis Propria ◽  
Enteric Neurons ◽  
Enzyme Assays ◽  
Nerve Bundles ◽  
Diethyldithiocarbamic Acid ◽  
Esophageal Muscle

Superoxide radical (O2-.) combines with nitric oxide (NO) to form peroxynitrite, thereby nullifying the biological activity of NO. Superoxide dismutase (SOD) prevents this reaction by converting O2-. to H2O2. We tested the hypotheses that the antioxidant enzymes catalase (CAT), Mn SOD, and Cu/Zn SOD are present in enteric neurons of the opossum esophagus, and that O2-. alters esophageal motor function. Immunostaining demonstrated CAT, Mn SOD, and Cu/Zn SOD immunoreactivity in interganglionic nerve bundles and ganglia of the myenteric and submucosal plexuses. Western blot analysis confirmed the presence of these enzymes in homogenates of esophageal muscularis propria, and enzyme assays demonstrated Cu/Zn SOD and Mn SOD activities of 262 and 73 U/mg protein, respectively. Both diethyldithiocarbamic acid, an inhibitor of Cu/Zn SOD, and xanthine (X) with xanthine oxidase (XO), which generate O2-., shortened the latency of the nerve-mediated contraction of circular esophageal muscle, the off response, by 20.2 and 23.4%, respectively. SOD alone did not affect the latency, but it inhibited the effect of X with XO on the latency. Antioxidant enzymes found in intramural esophageal nerves may play a role in regulating NO-mediated neuromuscular communication in the esophagus.

scholarly journals Characterization and mechanism of the esophago-esophageal contractile reflex of the striated muscle esophagus

2019 ◽  
Vol 317 (3) ◽  
pp. G304-G313 ◽  
Author(s):  
Ivan M. Lang ◽  
Bidyut K. Medda ◽  
Reza Shaker
Keyword(s):  
Nervous System ◽  
Smooth Muscle ◽  
Vagus Nerve ◽  
Enteric Nervous System ◽  
Esophageal Motility ◽  
Striated Muscle ◽  
Cervical Esophagus ◽  
Proximal Esophagus ◽  
Secondary Peristalsis

An esophago-esophageal contractile reflex (EECR) of the cervical esophagus has been identified in humans. The aim of this study was to characterize and determine the mechanisms of the EECR. Cats ( n = 35) were decerebrated, electrodes were placed on pharynx and cervical esophagus, and esophageal motility was recorded using manometry. All areas of esophagus were distended to locate and quantify the EECR. The effects of esophageal perfusion of NaCl or HCl, vagus nerve or pharyngoesophageal nerve (PEN) transection, or hexamethonium administration (5 mg/kg iv) were determined. We found that distension of the esophagus at all locations activated EECR rostral to stimulus only. EECR response was greatest when the esophagus 2.5–11.5 cm from cricopharyngeus (CP) was distended. HCl perfusion activated repetitively an EECR-like response of the proximal esophagus only within 2 min, and after ~20 min EECR was inhibited. Transection of PEN blocked or inhibited EECR 1–7 cm from CP, and vagotomy blocked EECR at all locations. Hexamethonium blocked EECR at 13 and 16 cm from CP but sensitized its activation at 1–7 cm from CP. EECR of the entire esophagus exists, which is directed in the orad direction only. EECR of striated muscle esophagus is mediated by vagus nerve and PEN and inhibited by mechanoreceptors of smooth muscle esophagus. EECR of smooth muscle esophagus is mediated by enteric nervous system and vagus nerve. Activation of EECR of the striated muscle esophagus is initially sensitized by HCl exposure, which may have a role in prevention of supraesophageal reflux.NEW & NOTEWORTHY An esophago-esophageal contractile reflex (EECR) exists, which is directed in the orad direction only. EECR of the proximal esophagus can appear similar to and be mistaken for secondary peristalsis. The EECR of the striated muscle is mediated by the vagus nerve and pharyngoesophageal nerve and inhibited by mechanoreceptor input from the smooth muscle esophagus. HCl perfusion initially sensitizes activation of the EECR of the striated muscle esophagus, which may participate in prevention of supraesophageal reflux.

PS01.106: PSEUDODIVERTICULOSIS-RELATED ESOPHAGEAL MASS WITH INTENSE FDG UPTAKE

2018 ◽  
Vol 31 (Supplement_1) ◽  
pp. 80-80
Author(s):  
Ryuichiro Sawada ◽  
Taro Oshikiri ◽  
Tetsu Nakamura ◽  
Yukiko Miura ◽  
Hiroshi Hasegawa ◽  
...  
Keyword(s):  
Conflicts Of Interest ◽  
Present Report ◽  
Minimally Invasive Esophagectomy ◽  
Muscularis Propria ◽  
Thoracic Esophagus ◽  
Esophageal Mucosa ◽  
Surgical Specimen ◽  
Invasive Esophagectomy ◽  
Esophageal Intramural Pseudodiverticulosis ◽  
Mass Formation

Abstract Background Esophageal intramural pseudodiverticulosis (EIPD) is rare condition. The usual symptom is dysphagia mainly due to benign stenosis, and other variety of symptoms and complications have been reported. Only few articles have shown EIPD leading to esophageal mass formation like malignancy. Here, we report EIPD related to esophageal mass with increased up take of 18F-fluorodeoxyglucose followed by esophagectomy. Methods A 48-year-old man presented with dysphagia caused by esophageal stricture. Esophagoscopy showed a protruding submucosal lesion and lumen stenosis in lower third of esophagus. The esophageal mucosa was intact, but one small hole was observed. Positron emission tomography-computed tomography showed the FDG-avid lesion in the lower esophagus. In addition to symptom persistence, possibility of malignancy offered him surgical resection. In the prone position, minimally invasive esophagectomy with gastric tube reconstruction was performed. Results The pathology of the surgical specimen showed that many cystic spaces lined by stratified squamous epithelium were present in the submucosa and partially in the muscularis propria. There was mucosal depression connecting with the cystic spaces, and submucosa was thickened with fibrosis. The dilated spaces formed flask-shaped lesion and intramural tracking parallel to the esophageal lumen. Based on these findings, esophageal intramural pseudodiverticulosis with no evidence of malignancy was diagnosed. The postoperative course was uneventful, and the patient was discharged 18 days after operation. Conclusion EIPD can result in inflammatory mass formation with high up take of FDG and the cavities can protrude into muscularis propria. The present report can be helpful in the assessment of PET-positive tumor. We should consider EIPD in unknown mass in the thoracic esophagus. Early diagnosis followed by conservative therapy may allow adequate control without surgery. The pathogenesis of EIPD remains to be fully clarified, and additional studies will be needed to elucidate the mechanism. Disclosure All authors have declared no conflicts of interest.

VS03.03: MINIMAL INVASIVE ESOPHAGECTOMY BY VIDEO ASSIST TRANSHIATAL-TRANSCERVICAL APPROACHE

2018 ◽  
Vol 31 (Supplement_1) ◽  
pp. 48-48
Author(s):  
Yuequan Jiang
Keyword(s):  
Thoracic Surgery ◽  
Lymph Nodes ◽  
Conflicts Of Interest ◽  
Minimally Invasive Esophagectomy ◽  
Distal Esophagus ◽  
Blunt Dissection ◽  
Thoracic Inlet ◽  
Invasive Esophagectomy ◽  
Cervical Incision ◽  
Wound Retractor

Abstract Description Trans hiatal esophagectomy avoid trans-thoracic surgery and reduce postoperative complications relate to thoracic surgery. However, the limitation of Trans hiatal esophagectomy is blunt dissection might result to some sever complications. We establish a video assistant transhiatal-transcervical approach (VATT) which can let the entire esophagus be dissected under video scope. Patient was in supine position, intubated with a single-lumen endotracheal tube. Abdomen part: Gastric was dissociated under laparoscope. Distal and middle part of the esophagus was dissected with the laparoscope also. The lower mediastinal lymph nodes including gas (figure 4), it let the dissection of upper esophagus and lymph nodes become easy under video scope. Cervical part: Two incisions in neck were made, a 3–4cm incision in left side, another 1–2cm incision in right side. From the left side incision, blunt dissection of the cervical esophagus was carried down to the level below thoracic inlet. The esophagus was cut off at the level of thoracic inlet. A traction tube was inserted into the distal esophagus. The end of traction tube was fixed to the cutting edge of distal esophagus; the top of the traction tube was taken out from a small incision made in lesser curvature of stomach. Pulling the traction tube slightly, the edge of esophagus was invaginated in the channel of esophagus; a space in the upper mediastinum was established. A trocar was placed in right side cervical incision. In the left side cervical incision, a device made by our-self was placed in. This device is consisted with a glove, a wound retractor protective sleeve and three trocars (figure 3). With this device, the mediastinum space can be gas, this let the dissection of upper esophagus and lymph nodes become easy under video scope. this technique was invented by ourself, so it is unique for the congress. This surgical technique was effective and safe, which can be applied as one of supplementary operation methods to traditional minimally invasive esophagectomy. Disclosure All authors have declared no conflicts of interest.

scholarly journals The role of the superior laryngeal nerve in esophageal reflexes

2012 ◽  
Vol 302 (12) ◽  
pp. G1445-G1457 ◽  
Author(s):  
I. M. Lang ◽  
B. K. Medda ◽  
S. Jadcherla ◽  
R. Shaker
Keyword(s):  
Motor Nerve ◽  
Superior Laryngeal Nerve ◽  
Esophageal Pressure ◽  
Upper Esophageal Sphincter ◽  
Laryngeal Nerve ◽  
Cervical Esophagus ◽  
Proximal Esophagus ◽  
Esophageal Sphincter ◽  
Secondary Peristalsis

The aim of this study was to determine the role of the superior laryngeal nerve (SLN) in the following esophageal reflexes: esophago-upper esophageal sphincter (UES) contractile reflex (EUCR), esophago-lower esophageal sphincter (LES) relaxation reflex (ELIR), secondary peristalsis, pharyngeal swallowing, and belch. Cats ( N = 43) were decerebrated and instrumented to record EMG of the cricopharyngeus, thyrohyoideus, geniohyoideus, and cricothyroideus; esophageal pressure; and motility of LES. Reflexes were activated by stimulation of the esophagus via slow balloon or rapid air distension at 1 to 16 cm distal to the UES. Slow balloon distension consistently activated EUCR and ELIR from all areas of the esophagus, but the distal esophagus was more sensitive than the proximal esophagus. Transection of SLN or proximal recurrent laryngeal nerves (RLN) blocked EUCR and ELIR generated from the cervical esophagus. Distal RLN transection blocked EUCR from the distal cervical esophagus. Slow distension of all areas of the esophagus except the most proximal few centimeters activated secondary peristalsis, and SLN transection had no effect on secondary peristalsis. Slow distension of all areas of the esophagus inconsistently activated pharyngeal swallows, and SLN transection blocked generation of pharyngeal swallows from all levels of the esophagus. Slow distension of the esophagus inconsistently activated belching, but rapid air distension consistently activated belching from all areas of the esophagus. SLN transection did not block initiation of belch but blocked one aspect of belch, i.e., inhibition of cricopharyngeus EMG. Vagotomy blocked all aspects of belch generated from all areas of esophagus and blocked all responses of all reflexes not blocked by SLN or RLN transection. In conclusion, the SLN mediates all aspects of the pharyngeal swallow, no portion of the secondary peristalsis, and the EUCR and ELIR generated from the proximal esophagus. Considering that SLN is not a motor nerve for any of these reflexes, the role of the SLN in control of these reflexes is sensory in nature only.

PS02.205: MALIGNANCY DEVELOPING IN CORROSIVE INJURED ESOPHAGUS

2018 ◽  
Vol 31 (Supplement_1) ◽  
pp. 180-180
Author(s):  
Servarayan Chandramohan ◽  
Kanagavel Manickavasagam ◽  
Madeshwaran Chinnathambi ◽  
Abishai Jebaraj ◽  
Apsara Chandramohan ◽  
...  
Keyword(s):  
Conflicts Of Interest ◽  
Cervical Esophagus ◽  
Time Interval ◽  
Enteric Fistula ◽  
Common Site ◽  
Lower Esophagus ◽  
Large Numbers ◽  
Upper Cervical ◽  
Gastric Pull Up

Abstract Background Malignancy developing in a corrosive injured esophagus has been described in the literature. Though the possibility of malignancy developing in a corrosive esophagus is expected to be around 1000 fold no team has managed large numbers. The aim of this study is to analyse the pattern of presentation and problems encountered in managing these difficult patients. Methods 13 patients with corrosive malignancy encountered between 1991 and 2016 were included in this study. Patients basic demographic profile, incidence, time interval between ingestion of corrosive and occurrence of malignancy, site of malignancy, symptoms at presentation, stage, management and survival were analysed. Results There were 10 males and 3 females. The age at presentation was between 35 and 52 years. The time taken between ingestion to presentation with cancer was between 13 and 29 years. The commonest presentation was dysphagia in 11, TEF in 1, UGI bleed in 1 patient. Most common site of malignancy is upper cervical esophagus (53.8%) either at the anastamotic site after coloplasty or at post cricoid region followed by middle (30.7%) and lower esophagus (7.75%) and OG junction (7.75%). 6 of them underwent definitive chemo RT, 3 were unwilling for any sort of management, 1 died within 24 hours due to aorto enteric fistula, 3 underwent THE and gastric pull up. Of these 9 patients only seven were under regular follow up. The survival in 3 patients who underwent THE respectively were 3.8, 5.5,7 years. The survival in patients who underwent Chemo RT was between 3 months and 15 months. Conclusion There were 10 males and 3 females. The age at presentation was between 35 and 52 years. The time taken between ingestion to presentation with cancer was between 13 and 29 years. The commonest presentation was dysphagia in 11, TEF in 1, UGI bleed in 1 patient.. Most common site of malignancy is upper cervical esophagus (53.8%) either at the anastamotic site after coloplasty or at post cricoid region followed by middle (30.7%) and lower esophagus (7.75%) and OG junction (7.75%). 6 of them underwent definitive chemo RT, 3 were unwilling for any sort of management, 1 died within 24 hours due to aorto enteric fistula, 3 underwent THE and gastric pull up. Of these 9 patients only seven were under regular follow up. The survival in 3 patients who underwent THE respectively were 3.8, 5.5,7 years. The survival in patients who underwent Chemo RT was between 3 months and 15 months. Disclosure All authors have declared no conflicts of interest.

Esophageal Stenosis and Thickening of the Muscularis Propria Diagnosed by Endoscopic Ultrasonography (EUS Diagnosis of Esophageal Muscle Thickening)

1991 ◽  
Vol 3 (2) ◽  
pp. 188-193 ◽  
Author(s):  
Masahiro IKEDA ◽  
Masayuki A. FUJINO ◽  
Yuichiro KOJIMA ◽  
Toshiya NAKAMURA ◽  
Hiroshi SUZUKI
Keyword(s):  
Endoscopic Ultrasonography ◽  
Muscularis Propria ◽  
Esophageal Stenosis ◽  
Esophageal Muscle

PS01.100: THORACOSCOPIC MANAGEMENT OF ESOPHAGEAL LEIOMYOMA: 11 CASE REPORTS

2018 ◽  
Vol 31 (Supplement_1) ◽  
pp. 77-78
Author(s):  
Yener Aydin ◽  
Atila Eroglu ◽  
Ali Ulas ◽  
Emre Kuran ◽  
Sevilay Ozmen
Keyword(s):  
Hospital Stay ◽  
Conflicts Of Interest ◽  
Case Reports ◽  
Postoperative Mortality ◽  
Length Of Hospital Stay ◽  
Absorbable Suture ◽  
Esophageal Leiomyoma ◽  
Esophageal Tumors ◽  
Thoracoscopic Enucleation ◽  
The Mean

Abstract Background The vast majority of esophageal tumors are cancer. Benign esophageal tumors constitute less than 1% of all esophageal tumors. Approximately 80% of benign esophagus tumors are leiomyomas. This study aims to evaluate outcomes of thoracoscopic management of esophageal leiomyomas. Methods Between January 2010 and December 2017, eleven cases (5 females, 6 males; mean age 45 years; range 30 to 59 years) who were operated with thoracoscopic resection due to esophageal leiomyoma were retrospectively analyzed. Age and sex of the patients, symptoms, localization of lesions, diagnosis, surgical modality, length of hospital stay and morbidity and mortality rates were reviewed. All cases were preoperatively examined using direct chest radiography, computed tomography (CT), and esophagoscopies, with endoscopic ultrasonography (EUS) also being employed in seven cases. Results Five patients had dysphagia and four patients were asymptomatic. Leiomyoma was located in 1/3 of the middle esophagus in all cases. All patients underwent right thoracoscopic enucleation (Single port incision in three cases). Leiomyoma was a solitary lesion in all cases. After the enucleation, 0.9% NaCl was inserted into the posterior mediastinal region. Nasogastric tube was inflated to check for leakage. Except for two cases, in all cases, the esophageal muscle layer was closed as an absorbable suture. The mean diameter of leiomyoma was 5.1 cm (range, 2 to 9 cm). Postoperative mortality was not observed in any of the cases. Postoperative pseudodiverticulum occurred in one of the cases. The mean length of hospital stay was 5.8 days (range, 4 to 11 days). Conclusion In esophageal leiomyomas, surgery provides both definitive diagnosis and treatment. Thoracoscopic enucleation in esophageal leiomyomas is an effective and safe treatment method. Disclosure All authors have declared no conflicts of interest.

Sign in / Sign up

Export Citation Format

Share Document