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Related Concept Videos

Esophageal Strictures-I: Introduction01:30

Esophageal Strictures-I: Introduction

311
Esophageal strictures involve abnormal narrowing or tightening of the esophagus. They vary in length and severity, ranging from mild constriction to complete obstruction, and are classified as benign (noncancerous) or malignant (cancerous).
Etiology
The primary cause of esophageal strictures is long-standing gastroesophageal reflux disease (GERD), accounting for about 70 to 80% of adult cases. Chronic acid reflux can lead to injury and scarring of the esophageal lining, culminating in...
311
Esophageal Varices-II: Clinical Features and Management01:28

Esophageal Varices-II: Clinical Features and Management

172
Esophageal varices often manifest as gastrointestinal bleeding episodes, presenting symptoms like hematemesis (vomiting of blood), hematochezia (passing fresh blood via the rectum), and melena (black, tarry stools). Other signs can include weight loss, anorexia, abdominal discomfort, jaundice, pruritus, altered mental status, and muscle cramps.
In the initial assessment, a thorough review of the patient's medical history is vital to identify risk factors such as liver disease, alcohol...
172
Esophageal Strictures-II: Clinical Features and Management01:26

Esophageal Strictures-II: Clinical Features and Management

186
Patients with esophageal strictures often experience a range of symptoms. Initially, they may have difficulty swallowing solid foods, which can progress to include liquids. Additional symptoms may involve chest pain or discomfort, regurgitating food and fluids, heartburn, unintentional weight loss, coughing or choking during meals, and hoarseness.
Healthcare providers should gather a comprehensive medical history and conduct a physical examination for diagnosis. If esophageal stricture is...
186
Esophageal Varices-I: Introduction01:24

Esophageal Varices-I: Introduction

425
Esophageal varices are dilated, tortuous veins which are found mainly in the submucosa of the lower esophagus but which may also appear higher up or extend into the stomach. They develop due to increased pressure in the portal venous system, often as a result of liver cirrhosis. This condition scars and damages the liver, impeding normal blood flow through the portal vein. To compensate, blood seeks alternative pathways, forming fragile new vessels (varices) in the esophagus and stomach. These...
425
Barrett Esophagus-II: Clinical Manifestations and Management01:21

Barrett Esophagus-II: Clinical Manifestations and Management

338
Individuals with Barrett's esophagus are often asymptomatic, but they may experience symptoms commonly associated with GERD, such as heartburn and acid regurgitation. Additional symptoms can include difficulty swallowing, chest pain, unintentional weight loss, blood in the stool (which may appear black, tarry, or bloody), and episodes of vomiting.
To diagnose Barrett's esophagus, healthcare providers often recommend an endoscopy for those showing symptoms of acid reflux. The procedure...
338
Esophageal Perforation-II: Clinical Manifestations and Management01:28

Esophageal Perforation-II: Clinical Manifestations and Management

170
Esophageal perforations manifest in various clinical forms, influenced by factors such as the perforation's cause and location (cervical, intrathoracic, or intra-abdominal), the extent of contamination, and potential injury to adjacent mediastinal structures. The timing between the perforation occurrence and treatment initiation also affects the clinical presentation.
Clinical Manifestations:
170

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An Ivor Lewis Esophagectomy Designed to Minimize Anastomotic Complications and Optimize Conduit Function
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Rural-Urban Differences in Esophagectomy for Cancer.

Joseph G Brungardt1, Omar A Almoghrabi2, Carolyn B Moore2

  • 1Department of Surgery, University of Kansas Medical Center, Kansas City, KS.

Kansas Journal of Medicine
|December 10, 2021
PubMed
Summary

Rural and urban patients had similar outcomes after esophagectomy for esophageal cancer. This study suggests equivalent postoperative care, reassuring for rural patients, though further research is needed for equitable treatment.

Keywords:
esophageal cancergeographyhealth care disparitiesrural health servicesurban health

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Area of Science:

  • Surgical Oncology
  • Health Services Research
  • Rural Health Disparities

Background:

  • Patients in rural areas or with socioeconomic disadvantages may avoid high-volume centers for complex surgeries, potentially impacting outcomes.
  • Esophagectomy for cancer is a complex procedure where access to specialized care may vary by geographic location.

Purpose of the Study:

  • To compare outcomes of esophagectomy for cancer between rural and urban patients based on their place of residence.
  • To identify potential disparities in postoperative care and outcomes for rural versus urban populations undergoing this procedure.

Main Methods:

  • Analysis of the Healthcare Cost and Utilization Project National Inpatient Sample (HCUP-NIS) database.
  • Stratification of adult patients with esophageal cancer undergoing esophagectomy into rural and urban groups using the National Center for Health Statistics Urban-Rural Classification Scheme.
  • Comparison of demographics, hospital variables, and key patient outcomes between the two groups.

Main Results:

  • A total of 2,877 esophagectomy patients were analyzed, with 7.92% from rural and 89.50% from urban areas.
  • No significant differences were observed in mortality rates (3.95% rural vs. 4.27% urban) or length of hospital stay between rural and urban patients.
  • Rural patients showed a trend towards higher rates of discharge to home (35.96% vs. 29.79%).

Conclusions:

  • This study indicates that rural and urban patients receive comparable postoperative care following esophagectomy for cancer.
  • The findings are reassuring regarding major outcomes, suggesting no significant disparity based on residence location.
  • Further research is warranted to ensure equitable treatment and access to care for rural patients undergoing esophagectomy.