Thoracic 7

What is the best approach to treating a young, high functioning patient with newly diagnosed small cell tumor of the esophagus 5cm above the GE junction and no evidence of metastases on imaging?

A 28-year-old patient with a history of Osler-Weber-Rendu syndrome presents with an incidentally discovered small, asymptomatic, nodular tumor involving the esophageal submucosa 4cm above the GE junction. The best approach to management is:

A 60-year-old female undergoes yearly endoscopy for follow-up of Barrett’s esophagus. Nodularity is seen at 38cm. Biopsy shows areas of high-grade dysplasia and invasive carcinoma. The next step is:

Endoscopy demonstrates an esophageal mass at 38 cm. Biopsy confirms adenocarcinoma. EUS shows a clinical T2N0Mx tumor. PET is negative for distant metastasis. The patient should be counseled about the following treatment plan:

EUS is performed for an esophageal mass at 40-cm, which extends to muscularis propria. Two 1.5cm (short axis) lymph nodes are noted adjacent to the mass. The lymph nodes are not accessible without going through the tumor. Next step in management of this patient is:

During Ivor Lewis esophagectomy which part of the airway is most commonly injured:

A 60-year-old chronic smoker with heavy alcohol intake is diagnosed with a proximal esophageal squamous cell carcinoma at 15 cm. The standard approach to definitively treat this tumor is:

63-year-old chronic smoker is diagnosed with T3N1M0 squamous cell cancer of the distal esophagus. After his EUS and biopsy, he had to be admitted for bronchitis and remained on O2 for 2 weeks. His PFTs are, FEV1 45% of predicted, DLCO 33% of predicted. A pre-operative echocardiogram shows LVEF 65%, 3+ tricuspid regurgitation and estimated pulmonary artery pressure of 60/23mmHg. Your recommendation for his treatment is:

Three days after an uncomplicated Ivor Lewis esophagectomy, the patient becomes septic and has to be intubated due to respiratory failure. CXR, non-contrast chest CT, and bronchoscopy fail to reveal an underlying etiology. No anastomotic leak or mediastinal collection is noted. What is the next step in management of this patient:

Which of the following eliminates the possibility of using the stomach to create a viable conduit:

A 65-year-old man undergoes endoscopy for worsening dysphagia. A nearly obstructing mass is noted at 37cm. While trying to navigate around the mass, an iatrogenic esophageal perforation is noted and the endoscopist covers the perforation with a covered esophageal stent. No biopsies were obtained. PET scan shows no distant metastases. After a few days in the hospital, the patient is discharged on a regular diet. Next step is:

A 65-year-old homeless man, with HIV, progressive dysphagia and 20 pound weight loss over 3 months is being worked up for a chronic pneumonia. The treating physician is concerned about esophageal cancer and a tracheo-esophageal fistula. Which of the following is the best first step in his workup?

A 34-year-old morbidly obese male with a BMI of 48 has significant gastroesophageal reflux refractory to maximal medical therapy. Endoscopy reveals a small hiatal hernia and Barrett’s esophagus without dysplasia. What is the best recommendation for treatment?

All of the following are true with regard to Barrett’s esophagus, EXCEPT:

Photodynamic therapy for Barrett’s esophagus:

Which is true regarding radiofrequency ablation of high-grade esophageal dysplasia?

Endoscopic mucosal resection should be considered for which of the following:

Which is true regarding biopsy for Barrett’s esophagus with suspected dysplasia?

What is the annual conversion rate of Barrett’s esophagus to cancer?

Which of the following is true regarding Barrett’s esophagus?