Demetrio Cavadas

Esophageal adenocarcinoma five years after laparoscopic sleeve gastrectomy. A case report

Highlights • There is big concern about reflux appearance after sleeve gastrectomy.• Chronic reflux increases risk of esophageal adenocarcinoma.• We present a case of an esophageal adenocarcinoma after sleeve gastrectomy.• Relationship between sleeve gastrectomy and reflux needs further study.

Pneumo-CT assessing response to neoadjuvant therapy in esophageal cancer: Imaging-pathological correlation

Pneumo-computed tomography (PnCT) is a technique primarily developed and used to study stenotic lesions of the esophagus, gastroesophageal junction and stomach for pre-surgical planning. It helps to define both upper and lower borders of neoplasms located in the aforementioned areas. It achieves maximum lumen distension with CO2 highlighting thickened areas of the esophageal wall, thus allowing an accurate quantification of their extents. Although there are other alternatives for distension (oral contrast agents, water and effervescent granules), they may be suboptimal. Patients with locally advanced esophageal cancer have a dismal prognosis despite surgical resection. Therefore, neoadjuvant treatment strategies using radiation therapy and chemotherapy were developed to improve survival. Neoadjuvant therapy improves esophageal tumor prognosis in a substantial proportion of patients, and the use of imaging techniques is mandatory to detect their response. PnCT combined with virtual endoscopy and multiplanar reconstruction enhances morphologic details in esophageal cancer, and thus would allow an improved assessment of response to neoadjuvant treatment. Therefore, more information could be provided to assess the efficacy of pre-surgical treatment. We describe the potential use of PnCT to assess the response to neoadjuvant therapy in esophageal cancer with an imaging pathologic correlation.

Giant Esophageal Lipoma

A 65-year-old woman, with previous history of severe kyphoscoliosis and obesity was referred to our hospital complaining of globus, dysphagia, and weight loss for several months. Physical examination was normal. An esophagogram revealed a well-defined mass with a large filling defect in the proximal esophagus, which caused intermittent obstruction. An upper gastrointestinal endoscopy showed a yellowish mass extending from the faringoesophageal junction to the lower middle esophagus, occupying most of its lumen. Diagnostic work-up was completed with a Pneumo 64-slice CT scan that evidenced a 100×47-mm, well-defined hypodense mass consistent with a lipoma, which displayed forward the trachea and bronchus as well as the pulmonary arteries (Fig. 1). An endoscopic resection was intended without success. A surgical exploration was then decided to resect the mass. Through a left lateral cervicotomy, once the esophagus was identified and dissected, a longitudinal esophagotomy was performed, and a soft mass covered with normal mucosa was recognized. The tumor was exteriorized through the esophagotomy and resected (Fig. 2). The patient was discharged without complications at postoperative day 5. The pathology study revealed a lipoma.

Outcomes of esophageal surgery, especially of the lower esophageal sphincter

This paper includes commentaries on outcomes of esophageal surgery, including the mechanisms by which fundoduplication improves lower esophageal sphincter (LES) pressure; the efficacy of the Linx™ management system in improving LES function; the utility of radiologic characterization of antireflux valves following surgery; the correlation between endoscopic findings and reported symptoms following antireflux surgery; the links between laparoscopic sleeve gastrectomy and decreased LES pressure, endoscopic esophagitis, and gastroesophageal reflux disease (GERD); the less favorable outcomes following fundoduplication among obese patients; the application of bioprosthetic meshes to reinforce hiatal repair and decrease the incidence of paraesophageal hernia; the efficacy of endoluminal antireflux procedures, and the limited efficacy of revisional antireflux operations, underscoring the importance of good primary surgery and diligent work‐up to prevent the necessity of revisional procedures.

Slipped Liver Segment Mimicking an Esophageal Stromal Tumor

A 36-year-old female patient with past medical history of a hiatal procedure in the neonatal period (which was not described in her medical history) for hiatal hernia was referred to our institution for thoracic pain. Abdominal examination was unremarkable. Initially, clinical tests (ECG and echocardiogram) were performed, ruling out cardiac pathology. Barium esophagramwas carried out evidencing a slight filling defect on the distal third of the esophagus with no evidence of recurrent hiatal hernia. A CT scan with distention technique (PnCT) revealed a homogeneous 39 × 26 mm lesion located on the distal esophagus consistent with a submucosal tumor (Fig. 1). An upper gastrointestinal endoscopy showed no organic lesion on the mucosa. Due to the suspicion of esophageal stromal tumor, we executed an endoscopic ultrasound (EUS) which revealed a well circumscribed, hipoechoic, relatively homogeneous mass arising apparently from the fourth layer of the esophagus. The case was presented to a multidisciplinary committee and based on the presumptive diagnosis of esophageal stromal tumor, the patient was considered candidate for resection and underwent an initial laparoscopic ap-

Intussusception as a complication of bariatric surgery in pregnant patients: report of one case and revision of the literature

Abstract Occlusive complications after a laparoscopic Roux-in Y gastric bypass (LRYGB), appear mainly as fibrous membranes of wounds, internal hernias or intussusception. Intussusception after a bariatric surgery occurs in 0.1–0.3% of the cases. We present a case of intussusception in a pregnant patient after a LRYGB.