Esophagus

Endoscopic Transesophageal Ultrasound (EUS)

The two most common types of esophageal cancer are squamous cell carcinoma, most often occurring in the upper and middle portions of the esophagus, and adenocarcinoma, affecting the mucous-secreting cells in the lower portion near the stomach. Risk factors for esophageal cancer include smoking, heavy alcohol use, and Barrett's esophagus, a condition in which the glandular cells of the lower portion of the esophagus are irritated by repeated exposure to stomach acid, often because of gastro-esophageal reflux disease (GERD).

To permit optimum therapeutic decision-making in treating patients with esophageal tumors, accurate staging is necessary. We use endoscopic transesophageal ultrasound (EUS) to visualize tumor depth, surrounding lymph nodes, and the tumor's relationship to adjacent structures. In combination with PET (positron emission tomography) and CT scanning, EUS is highly effective in properly staging tumors of the esophagus.


Esophageal Myotomy

Esophageal myotomy is a procedure performed in patients with achalasia to releive the discomfort of swallowing food. It involves cutting away some of the outer layers of tissue from the lower esophagus to allow food and liquids to pass into the stomach without obstruction.


Esophageal Perforation Repair

Esophageal perforation is a hole in the esophagus the permits escape of the caustic esophageal contents. This often results in infection of the mediastinum (mediastinitis). Surgery is often indicated within 24 hours. Treatment includes: fluid administration, antibiotics and draining of any fluid collection. Often a feeding tube is placed directly into the stomach while the esophagus is recovering. Surgery to repair a perforation may be either a simple repair or result in removal of the esophagus.


Esophageal Stent

An Esophageal Stent is a tube placed in the esophagus to keep a blocked area open so the patient can swallow food and liquids. Esophageal stents are often metallic and self-expandable.


Esophagectomy

A surgical procedure that involved removal of the esophagus, an esophagectomy can treat patients with esophageal cancer. If the cancer is detected at an early stage, an esophagectomy may be life saving. Despite significant improvements in technique and postoperative care, the long-term survival for esophageal cancer is challenging. Currently, multimodality treatment (surgery, chemotherapy and/or radiation therapy) are combined. Esophagectomy is infrequently performed for benign disease such as severe esophageal atresia in children, achalasia, or caustic injury.


Esophagoscopy

Esophagoscopy is a procedure in which a flexible endoscope is inserted through the mouth and into the esophagus. The procedure allows visualization of the esophagus from the upper esophageal sphincter (posterior aspect of the mouth) to the esophageal gastric (EG)junction (the point where the esophagus meets the stomach).


Evacuation of Hemothorax

Blood in the pleural space (traumatic or non-traumatic) can be associated with both hemorrhagic shock and respiratory compromise. It must be effectively evacuated to prevent complications such as fibrothorax and empyema. If chest radiography shows that a hemothorax is large enough to obscure the costophrenic sulcus or is associated with a pneumothorax, it is often drained by a chest tube placed at the bedside.


Fundoplication

Fundoplication involves wrapping part of the upper stomach around the lower end of the esophagus and suturing it in place. This supports the valve between the esophagus and stomach and helps prevent gastro-esophageal reflux (GERD).


Hiatal Hernia Repair

Any time an internal body part pushes into an area where it doesn't belong, it's called a hernia. The hiatus is an opening in the diaphragm -- the muscular wall separating the chest cavity from the abdomen. Normally, the esophagus (food pipe) goes through the hiatus and attaches to the stomach. In a hiatal hernia (also called hiatus hernia) the stomach bulges up into the chest through that opening. Hiatal hernia surgery can often be performed as a laparoscopic, or "minimally invasive," procedure. During this type of surgery, a few small (5 to 10 millimeter) incisions are made in the abdomen. The laparoscope that allows the surgeon to see inside the abdomen and surgical instruments are inserted through these incisions. The surgeon is guided by the laparoscope, which transmits a picture of the internal organs to a monitor. The advantages of laparoscopic surgery include smaller incisions, less risk of infection, less pain and scarring, and a more rapid recovery.
 

Port Placement

A port is a device implanted under the chest skin and allows an easy and reliable way to give very strong medicine intravenously. It is about a half inch thick and about the size of a quarter. You can feel its raised center under your skin. A flexible piece of tubing (catheter) is connected to it. This is tunneled under the skin to an area near the neck where it enters a vein. The center of the port is made of a tough, self-sealing, rubber-like material that can be punctured through the chest skin with a special needle many times. Each time it will reseal instantly.


Sympathectomy

Sympathectomy is an operative procedure that interrupts nerves, on the inner portion of the chest wall of the sympathetic nervous system. It is often used to decrease excessive sweating in various locations of the body.


Thoracoscopy

This is a procedure in which a thin tubular fiberoptic camera is inserted into the chest cavity through small incisions in the chest wall. Often referred to as a VATS (video assisted thoracoscopic surgery), and can be used to biopsy tissue samples, remove a portion of the lung (wedge resection, lobectomy, pneumonectomy). Thoracoscopic surgery is less invasive than open surgery and requires much smaller incisions.A major advantage is the shorter recovery period when compared to a much larger incision.