14 - Esophagus 2026

Serosa

What layer found in most GIT organs is ABSENT in the esophagus?

Cricopharyngeus muscle

At level of C6

What is the narrowest point of the esophagus?

Barium swallow

What is the first diagnostic test in most patients with suspected esophageal disease?

Esophageal manometry

What diagnostic test is requested when motor abnormality of the esophagus is suspected?

24-hour ambulatory pH monitoring

What test is the gold standard for the diagnosis of GERD?

GERD

What is the most common esophageal pathology?

6-26 mmHg

What is the normal resting pressure of the lower esophageal sphincter?

Intestinal goblet cells

The hallmark of intestinal metaplasia as seen in Barrett esophagus is the presence of what cells?

Proton pump inhibitors (PPIs)

What is the gold standard medical treatment for GERD?

Nissen fundoplication

Involves 360º fundoplication around the lower esophagus

What is the most common antireflux surgical procedure?

Toupet fundoplication (270º) and Dor fundoplication (180º)

What antireflux surgical procedures are considered alternatives to Nissen fundoplication and are partial fundoplications?

Chest pain

Retching with inability to vomit

Inability to pass an NGT

Indicative of incarcerated intrathoracic stomach

What are the components of Borchardt's triad?

Type I (sliding)

What is the most common type of diaphragmatic hiatal hernia?

Type II (rolling/paraesophageal) hernia

Which type of hiatal hernia is associated with dysphagia, postprandial fullness, gastric volvulus, and even infarction?

Paraesophageal hernia

This type of hiatal hernia will often require surgical repair with reduction of the hernia, repair of the diaphragmatic defect, and possible fundoplication

Sliding hiatal hernia

This type of hiatal hernia can be managed initially with medical treatment, then surgical repair if refractory

Zenker diverticula (false diverticulum)

What is the most common esophageal diverticula?

Kilian triangle

This area in the posterior pharyngeal wall is a natural area of weakness where Zenker diverticula herniate

Pulsion diverticula

This type of esophageal diverticula results from diffuse motility disorders of the esophagus

Barium swallow

Gold standard for the diagnosis of Zenker diverticulum

72/M presents with 2-year history of progressive dysphagia to both solids and liquids, halitosis, and regurgitation of undigested food several hours after meals. What is the most appropriate initial diagnostic test?

Manometry

What is the gold standard for the diagnosis of achalasia?

Achalasia

This esophageal motility disorder is characterized by loss of peristaltic waveforms in the esophageal body and failure of the LES to relax

Achalasia

Bird's beak esophagus as seen on esophagogram is pathognomonic for?

Heller myotomy + partial fundoplication

What is the surgical management of choice for achalasia?

Diffuse esophageal spasm (DES)

45/F presents with 6-month history of dysphagia to both solid and liquid foods. Manometric findings show simultaneous waveforms and multipeaked contractions. Esophagogram shows corkscrew deformity. Most likely diagnosis?

Nutcracker esophagus

What is the most common primary esophageal motility disorder?

Nutcracker esophagus

The normal LES pressure is 6-26 mmHg

This esophageal motility disorder is characterized by a mean peristaltic amplitude in the distal esophagus of >180 mmHg

Pain

What is the most striking and consistent symptom of esophageal rupture?

Boerhaave syndrome

This syndrome involves spontaneous rupture of the esophagus associated with a history of resisting vomiting. Associated with high mortality

Water-soluble contrast esophagogram (Gastrografin)

Not barium swallow due to risk of mediastinitis from barium extravasation

Alkali agents

___ agents are associated with liquefactive necrosis and are more destructive in the setting of caustic ingestion

Ulceration and granulation phase (3-5 days)

Not the time to perform endoscopy

Which phase of caustic injury is associated with the disappearance of symptoms, but is when the esophagus is weakest?

Mid-esophagus

What is the most common site of perforation in caustic ingestion?

Early endoscopy within 24 hours of ingestion

Timing of endoscopy for caustic ingestion?

Squamous cell carcinoma

What is the most common type of esophageal cancer worldwide?

Adenocarcinoma

What is the most common type of esophageal cancer in developed countries?

Middle 3rd of thoracic esophagus

Distal esophagus

What is the most common location of esophageal adenocarcinoma?

Barrett metaplasia

What is the precursor lesion of esophageal adenocarcinoma?

Barrett’s esophagus

What is the most important etiologic factor in the development of primary adenocarcinoma of the esophagus?

Squamous cell carcinoma and adenocarcinoma

Tobacco use is associated with what cancer of the esophagus?

Squamous cell carcinoma

Alcohol use is associated with what cancer of the esophagus?

Squamous cell carcinoma

Achalasia, caustic injury, and Plummer-Vinson syndrome are associated with what cancer of the esophagus?

Dysphagia

Occurs when 60% of the esophageal lumen is infiltrated

What is the most common presenting symptom of esophageal cancer?

Grade IV (most common)

Patients with esophageal cancer often present with dysphagia and are unable to take any solid food, tolerating liquids only. What functional grade of dysphagia is this?

Endoscopy (EGD) with biopsy

What is the gold standard for the diagnosis of suspected esophageal cancer?

Endoscopic ultrasound

Able to identify five distinct layers in the esophageal wall and thus provides an assessment of depth of tumor invasion

Which diagnostic provides the most accurate T- and N-staging in the evaluation of esophageal cancer?

Esophagectomy

What is the management for high-grade dysplasia in Barrett esophagus?

Chemoradiation

What is the standard non-surgical management of locally advanced esophageal carcinoma?

I – esophageal

II – cardiac

III – subcardiac

Siewert and Stein classification is used to classify esophagogastric carcinoma. What are the three types?

Iron-deficiency anemia

Dysphagia

Esophageal webs

Occurs in middle-aged edentulous women. Can be a premalignant lesion for SCCA

What is the triad of Plummer-Vinson syndrome?

Mallory-Weiss tears

These refer to mucosal tears at the GEJ associated with acute UGIB after repeated vomiting and with alcoholism.

Type C: EA with distal TEF

What is the most common type of tracheoesophageal atresia/fistula (TEF)?

Tracheoesophageal fistula with esophageal atresia

Inability to pass an NGT is the hallmark clinical sign of esophageal atresia

A full-term newborn develops excessive frothy oral secretions, coughing, and cyanosis during the first feeding attempt in the nursery. NGT insertion is unsuccessful. CXR shows the NGT coiled in the upper esophageal pouch with absence of gastric air bubble. Most likely diagnosis?