ЕЕsophageal disease (stricture, sophageal disease (stricture, diverticula, achalasia)diverticula, achalasia)

Surgery department Surgery department №2№2,,

DSMADSMA

Clinical picture of esophageal Clinical picture of esophageal diverticuladiverticula

Food regurgitation might occur when Food regurgitation might occur when standing, bending or lying downstanding, bending or lying down

Patients might develop dysphagia Patients might develop dysphagia (difficulty swallowing)(difficulty swallowing)

CChronic coughinghronic coughing CChest painhest pain HHeartburn eartburn WWeight loss eight loss

Esophageal diverticula Esophageal diverticula classificationclassification

By acuirence:By acuirence: congenitalcongenital acquiredacquired

By By quantityquantity:: single single mmultipleultiple

By localisationBy localisation crcryycopharyngeal copharyngeal (or Zencer)(or Zencer) midoesophagealmidoesophageal epiphrenicepiphrenic

Clinical picture of esophageal Clinical picture of esophageal diverticuladiverticula

As food collects in the pockets, it As food collects in the pockets, it promotes bacteria in the esophagus, promotes bacteria in the esophagus, which also leads to halitosis (bad breath). which also leads to halitosis (bad breath).

A patient’s voice also might change. A patient’s voice also might change.

Diagnostic of esophageal Diagnostic of esophageal diverticuladiverticula

EsophagoscopyEsophagoscopy

Chest X-rayChest X-ray

Contrast esophagographyContrast esophagography

Chest X-rayChest X-ray

DiverticulectomyDiverticulectomy

DiverticulectomyDiverticulectomy

DiverticulectomyDiverticulectomy

Esophageal achalasiaEsophageal achalasia

A rare motor disorder of the esophagus A rare motor disorder of the esophagus characterized by inability of the characterized by inability of the lower lower esophageal sphincteresophageal sphincter and and esophagealesophageal

muscle to relax as well as muscle to relax as well as dilationdilation of the of the esophagusesophagus

Esophageal achalasiaEsophageal achalasiaclinical pictureclinical picture

DysphagiaDysphagia (most common) (most common) RegurgitationRegurgitation Chest painChest pain HeartburnHeartburn Weight lossWeight loss

Esophageal achalasiaEsophageal achalasiaclassificationclassification

There are four stages:There are four stages:1.1. Functional spasm with out gullet extensionFunctional spasm with out gullet extension

2.2. Stable spasm with moderate gullet Stable spasm with moderate gullet extension but peristalsis is savedextension but peristalsis is saved

3.3. Scar changes of esophageal wall with Scar changes of esophageal wall with pronounced its dilatation, peristalsis is pronounced its dilatation, peristalsis is absentabsent

4.4. Pronounced gullet dilatation with its S-type Pronounced gullet dilatation with its S-type bending and erosive esophagitisbending and erosive esophagitis

Esophageal achalasiaEsophageal achalasia diagnostic diagnostic

Contrast esophagography (barium Contrast esophagography (barium swallowing)swallowing)

FibroesophagoscopyFibroesophagoscopy

Manometry Manometry

BiopsyBiopsy

Achalasia treatmentAchalasia treatment

In 1 and 2 stage – conservative treatment In 1 and 2 stage – conservative treatment with spasmolitics or its combination with with spasmolitics or its combination with submucose botex injectionsubmucose botex injection

In 1, 2 and 3 stage baloon dilatation is In 1, 2 and 3 stage baloon dilatation is appropriable appropriable

In 3 and 4 stage – just only myotomy by In 3 and 4 stage – just only myotomy by Heller or Petrovskiy could be providedHeller or Petrovskiy could be provided

Esophageal strictureEsophageal stricture

An esophageal stricture is a gradual An esophageal stricture is a gradual narrowing of the esophagus, which can narrowing of the esophagus, which can lead to swallowing difficulties.lead to swallowing difficulties.

The strictures are caused by scar tissue The strictures are caused by scar tissue that builds up in the esophagus. that builds up in the esophagus.

When the lining of the esophagus is When the lining of the esophagus is damaged, scarring develops. damaged, scarring develops.

When scarring occurs, the lining of the When scarring occurs, the lining of the esophagus becomes stiff. esophagus becomes stiff.

In time, as this scar tissue continues to In time, as this scar tissue continues to build up, the esophagus begins to narrow build up, the esophagus begins to narrow in that area. in that area.

Esophageal stricture Esophageal stricture

Esophageal stricture Esophageal stricture clinical pictureclinical picture

HeartburnHeartburn DDysphagiaysphagia OOdynophagiadynophagia FFood impactionood impaction WWeight losseight loss CChest pain. hest pain.

Esophageal strictureEsophageal stricture diagnostic diagnostic

Contrast esophagography (barium Contrast esophagography (barium swallowing)swallowing)

FibroesophagoscopyFibroesophagoscopy

BiopsyBiopsy

Esophageal stricture treatmentEsophageal stricture treatment

Dilation. The esophagus is stretched by Dilation. The esophagus is stretched by passing a dilator or air-filled balloon is passing a dilator or air-filled balloon is passed through a endoscope.passed through a endoscope.

Repeated dilation may be necessary to Repeated dilation may be necessary to

prevent the stricture from returning. prevent the stricture from returning.

Esophageal stricture treatmentEsophageal stricture treatment

If is performed if a stricture can't be dilated If is performed if a stricture can't be dilated enough to allow solid food to pass through. enough to allow solid food to pass through.

Surgery is also performed if repeated Surgery is also performed if repeated dilations do not keep these strictures from dilations do not keep these strictures from returning.returning.

Esophageal bypass graftingEsophageal bypass grafting(Esophagoplasty)(Esophagoplasty)

Total colonoesophagoplastyTotal colonoesophagoplasty

Total gastroesophagoplastyTotal gastroesophagoplasty

Total jejunoesophagoplastyTotal jejunoesophagoplasty

Thanks for your attention