The study carried out 28 patients whose endoscopic images were doubted esophageal carcinoma. These patients were diagnosing and staging by endoscopic ultrasonography. The results show that 24 cases were diagnosed esophageal carcinoma by endoscopic ultrasonography in which 23 cases were reidentified by biopsy or surgery. One case was not reidentified because this patient has no surgery and biopsy (-). 4 cases were diagnosed non esophageal carcinoma by endoscopic ultrasonography and reidentified by surgery, biopsy and treatment. 12 cases were operated to evaluated the efficacy of endoscopic ultrasonography in infiltrative stage and local lymph node. This data pointed out that the true endoscopic of ultrasonography was 10/12 (84%) in T stage and 9/11 (81%) in N stage. The study showed primarily that endoscopic ultrasonography was a quanlitative method in diagnosis of esophageal carcinoma.
Endoscopy ; Ultrasonography ; Carcinoma ; Esophageal Diseases ; Esophageal Neoplasms

Advances in diagnostic modalities and improvement in surveillance programs for Barrett esophagus has resulted in an increase in the incidence of superficial esophageal cancers (SECs). SEC, due to their limited metastatic potential, are amenable to non-invasive treatment modalities. Endoscopic ultrasound, endoscopic mucosal resection, and endoscopic submucosal dissection (ESD) are some of the new modalities that gastroenterologists have used over the last decade to diagnose and treat SEC. However, esophageal stricture (ES) is a very common complication and a major cause of morbidity post-ESD. In the past few years, there has been a tremendous effort to reduce the incidence of ES among patients undergoing ESD. Steroids have shown the most consistent results over time with minimal complications although the preferred mode of delivery is debatable, with both systemic and local therapy having pros and cons for specific subgroups of patients. Newer modalities such as esophageal stents, autologous cell sheet transplantation, polyglycolic acid, and tranilast have shown promising results but the depth of experience with these methods is still limited. We have summarized case reports, prospective single center studies, and randomized controlled trials describing the various methods intended to reduce the incidence of ES after ESD. Indications, techniques, outcomes, limitations, and reported complications are discussed.
Barrett Esophagus ; Esophageal Neoplasms ; Esophageal Stenosis* ; Humans ; Incidence ; Polyglycolic Acid ; Prospective Studies ; Stents ; Steroids ; Ultrasonography

Esophageal leiomyoma derived from the muscularis mucosae (MM) is a rare condition, and the optimal modality for diagnosis and treatment is controversial. Endoscopic ultrasonography can provide an accurate image of esophageal layer structure, providing information on lesion suitability for potential endoscopic therapy. We attempted to investigate the diagnostic value of a transendoscopic balloon-tipped miniature ultrasonic endoprobe for small esophageal leiomyomas derived from MM. We resected 7 small esophageal leiomyomas derived from MM by endoscopic mucosal resection (EMR), all of which were diagnosed by a balloon-tipped endoprobe. The endosonographic and pathologic features of 7 cases of small esophageal leiomyomas derived from MM were compared. The balloon-tipped endoprobe clearly showed all 7 small esophageal leiomyomas derived from MM, even those under 5 mm in size (smallest lesion, 3.0 mm). The endosonographic characteristics of small esophageal leiomyomas derived from MM were a hypoechoic mass with smooth, regular, and a well-defined outer margin and homogenous inner echogram arising from the second hypoechoic layer. Complete resections were possible in all 7 cases by EMR without any complications. Tumor size was 3.0 - 13.5 mm (mean 7.8 mm) in maximum diameter. In all cases, endosonographic findings by endoprobe were exactly concordant with pathologic finding in determining the tumors depth in the esophageal wall, tissue origin and characteristics, growth pattern, and size. We detail the balloon-tipped endoprobe is a simple, convenient, and very useful in making accurate diagnosis of small esophageal leiomyomas derived from the MM and the appropriate applications of EMR.
Adult ; *Endosonography ; Esophageal Neoplasms/pathology/*ultrasonography ; Esophagoscopy/*methods ; Female ; Humans ; Leiomyoma/pathology/*ultrasonography ; Male ; Middle Aged ; Mucous Membrane/pathology

BACKGROUND: With the advent of stage-adapted multimodal regiments for esophageal malignancy, accurate staging has become of utmost importance. Endoscopic ultrasonography(EUS) is a diagnostic method for the local staging of esophageal cancer, in particularfor T and N evaluation. The aim of this study was to examine the diagnostic efficacy of the EUS and to evaluate the relation between prognosis and EUS findings. MATERIAL AND METHOD:We reexamined the cases of 88 consecuitive patients who underwent transthroacic esophagectomy and cervical esophagogastrostomy for esophageal cancer from January 1991 to July 2001. We compared EUS findings, histological results and outcomes. RESULT: There were 83 male(94.3%) and 5 female. Median age was 61.3 years old. Overall staging accuracy were 59.0% for T staging and 76.0% for N staging, In early T staging group, the accuracy was 74.9% except T4 stage. However significant differences were not found in the ability of EUS: determined T stage and N-stage to predict survival. Multivariate analysis showed EUS-stage to predict survival. CONCLUSION: EUS provides a high degree of accuracy in assessing both T and N parameters in staging esophagal cancer. EUS should be performed in all patients with esophageal cancer, not only for staging before therapy, but also as a valuable method of determining prognosis.
Esophageal Neoplasms* ; Esophagectomy ; Female ; Humans ; Multivariate Analysis ; Neoplasm Staging ; Prognosis ; Ultrasonography*

Zenker's diverticulum, a pulsion diverticulum of the hypopharynx, is a rare lesion that commonly occurs in left side of hypopharynx. The incidence of esophageal diverticula is much lower than that of focal lesions or nodules of thyroid. In an ultrasonography, the outpouching just like a focal thyroid lesion, may present as an oval or circular structure. The food remnants or gas bubbles present in the diverticulum may mimic microcalcifications presented in papillary thyroid carcinoma. We reported a case of right side Zenker's diverticulum mimicking a thyroid cancer in thyroid ultrasonography.
Diverticulum ; Diverticulum, Esophageal ; Hypopharynx ; Incidence ; Thyroid Gland ; Thyroid Neoplasms ; Thyroid Nodule ; Ultrasonography ; Zenker Diverticulum

Cytologic diagnosis of the metastatic tumors to the thyroid is important in the management of the patients. There have been rare reports analyzing fine-needle aspiration (FNA) cytology of metastatic tumors to the thyroid. This study examines comprehensive cytologic findings of metastatic tumors to the thyroid with radiologic findings. The FNA cytology slides obtained from 12 cases with metastatic tumors of the thyroid; lung cancer (n=5), tongue and tonsil cancer (n=3), esophageal cancer (n=2), and breast cancer (n=2) were reviewed. Radiological study showed single mass with heterogeneous texture or multiple masses without calcification. Metastatic tumor was easily considered in a differential diagnosis of FNA cytology because they had peculiar cytological features which were not seen in primary thyroid tumor. The smear background varied from predominantly necrotic, bloody, and inflammatory to colloid. The aspirates exhibited a mixture of benign follicular cells and malignant cells in 6 cases. The characteristic cytoplasmic features of the tumor cells, such as keratin, mucin and melanin, were found in 9 cases. Although some cases mimic primary thyroid neoplasm, a careful examination of the cytological characteristics may help cytopathologists to recognize a metastatic tumor in the thyroid by FNA, and may help the clinicians to establish a proper treatment plan.
Biopsy, Fine-Needle* ; Breast Neoplasms ; Colloids ; Cytoplasm ; Diagnosis ; Diagnosis, Differential ; Esophageal Neoplasms ; Humans ; Lung Neoplasms ; Melanins ; Mucins ; Thyroid Gland* ; Thyroid Neoplasms ; Tongue ; Tonsillar Neoplasms ; Ultrasonography*

OBJECTIVETo summarize the experience of diagnosis and treatment of esophageal leiomyoma.

METHODSClinical data of 52 patients with esophageal leiomyoma were analyzed from 1993 to 2002.

RESULTSAbout 54% patients in this group had difficulty of food intake. The diagnostic accuracy of gastrointestinal barium meal series, computed tomography, gastric endoscope and endoscopic ultrasonography (EUS) for esophageal leiomyoma was 64% 44% 27% and 90% respectively. All patients received operation, resection of esophageal leiomyoma by videothoracoscopy (VAS) and endoscope were performed in 6, 9 patients respectively. The remaining 37 patients received regular open operation,in whom 32 cases received enucleation of esophageal leiomyoma, 5 cases received partial esophageal resection and esophageal-gastric anastomosis. No serious complications occurred except only one case needed operation again because of bleeding.

CONCLUSIONEUS is an effective method for diagnosing esophageal leiomyoma. VAS and endoscopic treatment should be considered for suitable cases in order to reduce the trauma.

Esophageal Neoplasms ; diagnostic imaging ; surgery ; Female ; Follow-Up Studies ; Humans ; Leiomyoma ; diagnostic imaging ; surgery ; Male ; Middle Aged ; Thoracoscopy ; Ultrasonography

Metastatic cancers in the spermatic cord are extremely rare. A 79-year-old man, who had undergone palliative chemotherapy and radiotherapy one year previously, due to inoperable esophageal cancer, visited our hospital suffering from right inguinal swelling. Ultrasonography showed echogenic lesions superior to the right testis, suspicious of a swollen bowel loop. An emergency exploration revealed no bowel content or mesentery, but with thickened of the spermatic cord and epididymis four times that of the contralateral side. Pathology confirmed a metastatic carcinoma, likely to have originated from the esophagus.
Aged ; Drug Therapy ; Emergencies ; Epididymis ; Esophageal Neoplasms* ; Esophagus ; Hernia* ; Humans ; Male ; Mesentery ; Neoplasm Metastasis* ; Pathology ; Radiotherapy ; Spermatic Cord* ; Testis ; Ultrasonography

A 59-year old woman visited us for incidentally detected posterior mediastinal mass. Preoperative esophagography, esophagoscopy, esophageal ultrasound and computed tomography showed a esophageal submucosal tumor. With the diagonsis of esophageal leiomyoma, the patient underwent right side video-assisted thoracoscopic surgery (VATS): The mediastinal pleura and the esophageal muscle layers were longitudinally opened and the tumor was enucleated. Esophagography performed at 6th postoperative day revealed no esophageal mucosal bulging or leakage. The patient was discharged reveiving a soft diet on the 7th postoperative day. ha
Diet ; Esophageal Neoplasms ; Esophagoscopy ; Esophagus* ; Female ; Humans ; Leiomyoma* ; Middle Aged ; Pleura ; Thoracic Surgery, Video-Assisted* ; Thoracoscopy ; Ultrasonography

BACKGROUND: Despite the technical developments in diagnosis and therapy, esophageal cancer is highly lethal disease and the survival is largely dependent upon the stage of the disease. Preoperative cancer staging is crucial in choosing a therapeutic option as well as in predicting the prognosis of the patients. Staging has been based on computerized tomography (CT) and transabdominal ultrasonography. However CT has a limit in pre-cisely discriminating the depth of invasion or the lymph node metastases. With the devel-opment of endoscopic ultrasonography (EUS) and with its superiority in delineating wall structure and detecting lymph node metastases, its usefulness in staging for esophageal cancer has been cknowledged. In order to evaluate the accuracy of EUS, we compared EUS with pathologic findings in patients with esophageal carcinoma. METHODS: From July 1990 to August 1997, 136 patients with esophageal cancer received preoperative cancer staging with EUS. Among them, 48 patients who underwent surgical procedures with the intention of radical resection were included. We compared the EUS and pathologic find-ings and analysed the accuracy of EUS for preoperative staging. RESULTS: The overall accu-racy of EUS for T-staging was 43.8%. Twenty five percents of the patients (12/48) pre-sented high-grade tumor strictures, which precluded the passage of the endoscope. There was no statistical significance according to tumor site, size or gross morphology. However theaccuracy was significantly lower in tumors with ulceration than in tumors without ulceration (35.3% vs 64.3%, p=0.004). Mainly, ulceration in tumors caused significant overstaging of the T-stage. In the assessment of regional lymph node metastasis, the overall accuracy achieved by EUS was 66.6%; the sensitivity was 95.5%, specificity 42.3%, positive predictive value 58.3%, and negative predictive value 91.7%. Tumors with more than 2 lymph nodes rendered more accurate N-staging than tumors with less than 2 lymph nodes. CONCLUSIONS: In conclusion, the accuracy of the EUS for preoperative staging of esophageal cancer was not satisfactory, mostly influenced by ulceration in tumors and its resultant inflammatory reactions around the tumors, therefore more systematic study will be needed to establish the precise diagnostic criteria of EUS staging.
Constriction, Pathologic ; Diagnosis ; Endoscopes ; Endosonography* ; Esophageal Neoplasms* ; Humans ; Intention ; Lymph Nodes ; Neoplasm Metastasis ; Neoplasm Staging ; Prognosis ; Sensitivity and Specificity ; Ulcer ; Ultrasonography