Esophageal Diverticulum Research Articles

Killian-Jamieson diverticulum mimicking a suspicious thyroid lesion.

Key Clinical MessageKillian‐Jamieson diverticulum represents a rare form of esophageal diverticulum originating on the anterolateral wall of the cervical esophagus. Despite its rarity, it is crucial to recognize this entity, with such specific imaging findings, to avoid unnecessary invasive procedures such as fine‐needle aspiration or even surgery.

Weak Areas of the Pharyngoesophageal Narrowing (Pharyngoesophageal Union): Anatomic Description and Implication on the Development of Pharyngoesophageal Diverticulum

In the pharyngoesophageal narrowing ("pharyngoesophageal junction") there is a difference between the smooth and striated pharynx and esophagus, identifying points of weakness where pharyngoesophageal diverticula originate. In 1874 Albert von Zenker along with Ziemssen presented the first scientific publication on these diverticula. The aim of this work is to perform a surgical anatomical description and demonstration of the weak areas of the pharyngoesophageal narrowing ("pharyngo-esophageal junction") and its implication in the "Zenker diverticulum." We dissected Caucasian adult cadavers, in 5% formaldehyde and researched the pharyngoesophageal region with a review of the literature. In one case a markedly weak area was located presenting a true hernial sac. From the anatomo-surgical study of pharyngoesophageal narrowing ("pharyngeal esophageal junction") we observed the "weak pharyngoesophageal areas" in the pharynx, represented by a pharyngooesophageal diamond. It is crossed transversely by cricopharyngeal portion of the inferior constrictor muscle of the pharynx, and divides into two triangles, an upper, the "Killian Triangle" and a lower, "or Lannier Laimer Triangle Hackermann". Zenker's diverticulum originates from the "Killian Triangle" area of major weakness of the pharyngoesophageal narrowing ("pharyngoesophageal junction"). For its part, the lower triangle, "Laimer Triangle or Lannier Hackermann" where diverticula is rarely formed, because the space is occupied by a layer of circular fibers. The "Zenker diverticulum" represents 60-65% of all esophageal diverticula, and treatment is exclusively surgical. In order to understand and adequately treat this disease, specific knowledge of the anatomy of the area is necessary.

Resection of an Esophageal Diverticulum by Thoracoscopy in Prone Position

Diverticula of the middle one third of the esophagus are rare clinical entities, by comparison with the more common epiphrenic diverticula. For midesophageal diverticula, a minimally invasive approach has not been standardized. This report presents the case of a 60-year-old man with a large midesophageal diverticulum who was treated successfully by four-port video-assisted thoracic surgery while he was in the prone position. Thoracoscopy is a good approach for direct visualization of the diverticulum, and the prone position has several advantages to help clear the view. Routine myotomy for middle one-third diverticula is not advised, given the risk of poor functional results and diverticulization of the myotomy itself.

Asymptomatic Gastric Heterotopia in the Rectum? A Rare Finding with Unclear Malignant Risk

Introduction Gastric heterotopia (GHT) is the presence of normal gastric mucosa in extra-gastric regions in the gastrointestinal tract (GIT). The most common locations are the esophagus, duodenum, and Meckel's diverticulum, but rarely it may occur in the rectum resulting in symptoms and unclear long-term risk. Detailed Case Description We describe a case of a 27 year old, healthy woman, with a long-standing history of loose stools, up to 8 bowel movements per day, and bloating. After diagnostic workup including lactose-breath test, celiac screen, microbiologic, and endocrinologic work up as well as colonoscopy for microscopic colitis; the presumptive diagnosis was irritable bowel syndrome (IBS) - diarrhea subtype. Her colonoscopy revealed normal biopsies of the cecum, transverse colon; however, the rectum contained a well demarcated, erythematous region of approximately 1 inch diameter, adjacent to a prominent fold and resembling a flat polyp. Pathologic biopsy of the folds identified benign gastric mucosa and benign large intestinal mucosa respectively. The diagnosis of rectal GHT was made based on the presence of gastric oxyntic mucosa with chief, parietal, and foveolar cells. Hpylori was not seen. The patient's IBS was treated with diet and lifestyle intervention. Loperamide was used to reduce stool frequency. Repeat sigmoidoscopy 2 years later confirmed stable GHT in rectum. The patient responded well to a reduced gluten diet, and had resolution of her longstanding IBS. She remains stable 8 years after diagnosis with no active IBS symptoms, and no clinical concerns about her GHT. Discussion GHT distal to the foregut is believed to be caused by pluripotent stem cells abnormally differentiating into gastric mucosa. Common symptoms of GHT include abdominal pain and gastrointestinal bleeding but many cases are asymptomatic. A literature review demonstrates higher prevalence in males with a younger median age at diagnosis. Complications are more common in the pediatric population, while risk of malignant transformation is higher in adults. Treatment is with H2-receptor antagonists or proton-pump inhibitors for bleeding, or complete excision for refractory symptoms. Few cases of neoplastic changes are reported in the literature but further observation is needed to appreciate the risk and benefit of pre-emptive excision by surgery or endoscopic submucosal dissection.1614 Figure 1. Heterotopic gastric tissue in rectum

A Novel Indication of Per Oral Esophageal Myotomy in the Management of a Lower Esophageal Diverticulum

A Novel Indication of Per Oral Esophageal Myotomy in the Management of a Lower Esophageal Diverticulum

Schatzki ring in adult patients: Experience of a tertiary-stage center

Giriş ve Amaç: Shatzki halkası özofagus alt kısmında lümeni halka veya yüzük şeklinde daraltan yapılardır. Bu çalışmada Shatzki halkasının endoskopik bulgular ve diğer hastalıklar ile ilişkisini araştırmayı amaçladık. Gereç ve Yöntem: Bu çalışma Ocak 2014-Aralık 2015 tarihleri arasında endoskopi yapılan hastaların kayıtları incelenerek retrospektif olarak yapılmıştır. Toplamda 5.000 endoskopi kaydı incelenmiş ve Shatzki halkası tespit edilen 104 hasta çalışmaya dahil edilmiştir. Bulgular: Araştırma popülasyonu 46 kadın (%44,2) ve 58 erkek (%55,8) erkek hasta olmak üzere 104 kişiden oluştu. Hastaların ortalama yaşı 60,8±14,1 yıldı. Hastaların en sık başvuru endikasyonları disfaji (%26), dispepsi (%38,5) ve karın ağrısı (%28,8) idi. Endoskopi bulguları incelendiğinde hastaların %53,8’inde reflü özofajit, %50’sinde hiatal herni tespit edildi. Özofageal divertikül %4,8, başka web %1, özofageal ülser %5.7, özofageal polip %0,9, özofagus varisleri %1,9, özofagus motilite bozuklukluğu (hipertrofik alt özofagus sfinkteri) %1,9 ve Barrett özofagus %3,8 hastada tespit edildi. Hastaların %58’inde Helicobacter pylori, %19’unda demir eksikliği anemisi ve %5,7’sinde vitamin B12 eksikliği saptandı. Sonuç: Shatzki halkası aralıklı disfajinin önemli sebeplerinden biri olup reflü özofajit, hiatal herni ve demir eksikliği anemisi ile birliktelik göstermektedir.

A New Species ofSpirorchisMacCallum, 1918, (Digenea: Schistosomatoidea) andSpirorchis scriptaStunkard, 1923, Infecting River Cooter,Pseudemys concinna(Le Conte, 1830), (Testudines: Emydidae) in the Pascagoula River, Mississippi, U.S.A., Including an Updated Phylogeny forSpirorchisspp.

River cooters (Pseudemys concinna [Le Conte, 1830]) from the Pascagoula River (30°37′07.67″N; 88°36′44.53″W; Mississippi, U.S.A.) were infected by Spirorchis scripta Stunkard, 1923, and Spirorchis testiplexus n. sp. The new species resembles Spirorchis artericola (Ward, 1921) Stunkard, 1921, and Spirorchis innominatus Ward, 1921 (type species), by having a median esophageal diverticulum, ceca that extend slightly posterior to the genitalia, 10 testes, and a testicular column that extends anteriad to near the cecal bifurcation. Based on a comparative morphological study of existing type materials, vouchers, and published descriptions of similar congeners, S. testiplexus is unique by the combination of having a proportionally wider body, laterally directed cecal diverticula, deeply lobed testes, a testicular column that fills the intercecal space, and an external seminal vesicle that occupies the space between the posterior-most testis and the ovary and that passes dorsal or dorsolateral to the ovary. The large-subunit rDNA (28S) Bayesian inference phylogenetic analysis (including 16 turtle blood fluke species of 7 genera) showed a strongly supported monophyletic Spirorchis MacCallum, 1918, grouping sister to Spirhapalum siamensis Tkach, Snyder, and Vaughn, 2009.

A RARE CASE OF ESOPHAGEAL DIVERTICULUM WITH CLASSICAL PRESENTATION

Diverticula of the esophagus are rare, accounting for <1% of all barium gastrointestinal radiographs and <5% of all cases ofdysphagia. Here, we report a case of an 80-year-old male presented with the chief complaint of dysphagia for 8 months. Contraststudies with barium swallow and computed tomography (CT) scan were performed to diagnose the etiology behind dysphagia, andit turned out to be a case of esophageal diverticulum which demonstrates outpouching from the wall of the esophagus in bariumswallow and CT scan. These investigating modalities also aid in eliminating other causes of dysphagia.

Esophageal Diverticulum and Megaesophagus in a Dog and a Cat

Background: Esophageal diverticula are pouch-like dilatations in the esophageal wall that rarely affect dogs and cats, and may have the megaesophagus as a base cause. The definitive method of diagnosis is the contrasting chest X-ray that will visualize the sacculation.Cases: Case 1. A feline male, mixed breed, with 40 days of life was seen with complaint of postprandial regurgitation that was repeated at each meal. On physical examination, the animal was below ideal weight, apathetic, with pale mucosa and bristly. It was suspected of megaesophagus, which was confirmed by contrasting thoracic lateral-lateral (LL) radiography, and the patient also had anterior partial esophageal dilation to the topographic image of the heart. The image was suggestive of persistence of the right aortic arch, and corrective surgery was indicated but it was not authorized by the tutors. Therefore, conservative dietary treatment was instituted. The animal remained stable for a period of one and a half years. After this period the patient returned with an aggravated condition of vomiting, anorexia and apathy. The same clinical condition was maintained in the chest X-ray. An esophageal flushing was indicated, which was not authorized by the tutors, being prescribed mucosal protector and antibiotic. The medication was maintained by the tutor and after 1 month of the initial care, the clinical condition worsened and the animal died. Case 2. A 6-month-old male Pinscher dog weighing 1 kg was seen with postprandial regurgitation complaint since the beginning of the weaning transition period. In the esophagography performed a compatible radiographic image was seen with a diverticulum of the cranial thoracicesophagus and congenital total megaesophagus. The treatment adopted was conservative. Twelve months after the initial care, the animal presented radiographically resolution of the diverticulum and megaesophagus and was in good health.Discussion: These cases report two rare conditions of esophageal diverticulum associated with megaesophagus in a feline and canine. In the case of the feline, it was possible to conclude that the formation of the diverticulum was secondary to not surgical resolution of the persistence of the right aortic arch, with consequent maintenance of the megaesophagus,since the diverticulum was not present in the first radiographic examination. In the second case, when the radiograph was taken, the animal already presented the cranial diverticulum to the total megaesophagus, which, together with the history of postprandial vomiting since the 45 days of life, suggested a delay in the maturation of the esophageal nervous system that caused the megaesophagus and impairment of normal peristalsis of the organ culminating in the formation of the diverticulum. Due to the rare condition in both species, there are no reports of predilection for race, age or sex of the animals affected by the diverticulum, whereas for the megaesophagus, when in the congenital form, it preferentially occurs in young dogs and cats [less than 2 years of age], at the time of transition from the liquid to the solid diet. Both reportswere of young animals that had recently undergone a food transition, which would justify the appearance of the megaesophagus as the main cause of the esophageal diverticulum. The clinical signs presented by the animals were compatible with those reported in the literature. It is concluded that although the esophageal diverticulum occurred in both cases as aconsequence of megaesophagus, the resolution of the underlying cause is decisive for the resolution of the clinical condition determining the patient’s prognosis.Keywords: regurgitation, food impacts, esophageal dysfunction.

Su1139 PRIMARY STUDY ON SUBMUCOSAL TUNNELING ENDOSCOPIC SEPTUM DIVISION FOR ESOPHAGEAL DIVERTICULUM

Submucosal tunneling endoscopic septum division (STESD) is a minimal invasive surgical therapy for esophageal diverticulum. This study is to evaluate the efficacy and safety of this operation. Patients with typical symptoms (dysphagia, regurgitation, foreign body sensation, etc.) who received STESD during April 2016 to June 2017 were included in this study. Patients with atypical symptoms or those with other esophageal motility disorders were excluded. STESD was performed by 4 steps: 1) mucosal incision; 2) submucosal tunneling; 3) septum division; and 4) mucosal closure. SF-36 health survey was used for the assessment of quality of life. A total of 8 patients were included in this study, the mean age was 59.9 years old (range, 39-80). There were 3 male patients and 5 females. Among them, 3 (3/8, 37.5%) were diagnosed with Zenker’s diverticulum, 4 (4/8, 50.0%) were diagnosed with epiphrenic diverticulum, 1 (1/8, 12.5%) was diagnosed with mid-esophageal diverticulum. The mean procedure time was 47.0 mins (range, 22-106mins, SD, 27.6mins). The mean of hospital stay after surgery was 4.3 days (range, 3-9days, SD, 2.0days). Mucosal injury was found in 2 patients during the procedure, and was closed by hemostatic clips, no major adverse event was found during hospital stay or after discharge. The depth of diverticulum (vertical distance from the septum to the bottom) was 23.13±8.43mm before and 19.25±8.88mm after STESD (mean±SD, p=0.281, two-tail-t-test). 2 patients (2/8, 25.0%) were completely symptom-free, 5 (5/8, 62.5%) reported relieved symptoms after the procedure, and only one (1/8, 12.5%) complained no significant change after the surgery (Table 1). One patient was lost to follow up the SF-36 scale. In patients who accomplished the follow-up, the total score of SF-36 was 112.1±27.1 before and 134.9±10.0 after the procedure (mean±SD, p=0.034, t-test). Among 8 sub-scales analysis of SF-36, GH (general health) and VT (vitality) analysis after surgery showed significant improvement with those before surgery (p=0.018 in GH, p=0.013 in VT, t-test). Various degrees of weight gain after STESD were observed, except one patient who lost weight through exercising. Submucosal tunneling endoscopic septum division can efficiently improve patients’ quality of life, especially in general health and vitality. Furthermore, based on our pilot study to date, this procedure is safe, although prospective studies in large scales are still needed.Tabled 1Table 1. Main symptoms before and after STESDCaseSiteBeforeAfterMain SymptomSeverityFrequencyMain SymptomSeverityFrequency1Zenker’sChest tightnessModerateEverydayChest tightnessMildEverydayForeign body sensationModerateEveryday---2EpiphrenicRegurgitation of foodSevere1∼2/monthAcid refluxModerate3∼4/half a year3EpiphrenicDysphagiaSevereEverydayDysphagiaModerateEverydayRegugitation of foodMild1∼2/weekAcid refluxModerate1∼2/week4EpiphrenicDysphagiaSevereEveryday---5Zenker’sDysphagiaSevereEveryday------Foreign body sensation*Mild2∼3/week6EpiphrenicDysphagiaModerateEveryday------Gurgling after meal*Mild3∼4/week7Zenker’sDysphagiaSevereEveryday---8**Mid-esophagealDysphagiaSevereEverydayDysphagiaMild3∼4/weekAcid refluxModerateEveryday---*Emerging symptoms **Lost to follow-up at 4-month after STESD Open table in a new tab

The Spectrum of Surgical Remediation of Transoral Incisionless Fundoplication-Related Failures.

To evaluate outcomes of surgical remediation for symptomatic or anatomic failure after a transoral incisionless fundoplication (TIF). This retrospective study was performed on 11 patients who underwent a remedial operation following TIF failure between June 2011 and September 2016 at the Mayo Clinic in Florida for persistent foregut symptoms. Upper gastrointestinal workup characterized 1 patient as having normal post-TIF anatomy and 10 as having anatomic failure. Ambulatory pH testing was performed in 7 patients and was abnormal in all. All patients underwent a laparoscopic takedown of the prior endoscopic fundoplication and removal of all accessible polypropylene T-fasteners. All patients had esophageal salvage and have not required a reoperation. Anatomical findings included hiatal hernia (7), esophageal diverticulum (2), hiatal mesh erosion of esophagus (1), long-segment esophageal stricture (1), and normal anatomy (1). Remedial operations included laparoscopic explant of fasteners in all patients with conversion to fundoplication (7), resection/imbrication of esophageal diverticulum (2), Heller myotomy (1), and mesh explant and complex esophageal repair (1). Mean operative time was 177 minutes and median length of stay 3 days (range 2-13 days). At mean follow-up of 10.7 months (range 1-42 months), 7 patients had persistent complaints. Esophagogastroduodenoscopy was repeated in these 7 patients and was normal (n = 3), mild stenosis requiring dilation (n = 2), Los Angeles grade B esophagitis (n = 1), and Barrett's esophagus (n = 1). Anatomic distortion of the distal esophagus after TIF can be significant, making subsequent operations complex. After remedial surgery, few patients will continue to have troublesome symptoms such as dysphagia.

Resection of esophageal diverticulum through uniportal video-assisted thoracoscopic surgery

Open surgery remains the standard strategy for management of esophageal diverticulum in symptomatic patients. However, in the last years an increasing number of minimally invasive approaches have been proposed for this issue in order to reduce the surgical trauma and favor a fast return to daily activity. Herein, we describe a novel technique as uniportal video-assisted thoracoscopic surgery (VATS) for performing resection of esophageal diverticulum. This procedure was successfully carried out in three consecutive patients with giant mid-esophageal diverticulum (mean size: 6.5±0.5 cm). The mean post-operative time was 121±10 minutes. The chest drain was removed 48 hours later in all cases and the mean length of hospital stay was 9±1 days. No intraoperative neither postoperative complications were found in all patients but one. He had a small fistula 15 days later that was successfully treated with stent insertion. No recurrence of diverticulum was seen in all cases. Uniportal VATS is a feasible procedure that in theory could reduce the surgical trauma compared to standard open approach. However, future prospective studies should corroborate our impression before it can be recommended as acceptable therapy.

The Surgeon Volume-outcome Relationship: Not Yet Ready for Policy.

Increasing surgeon volume may improve outcomes for index operations. We hypothesized that there may be surrogate operative experiences that yield similar outcomes for surgeons with a low-volume experience with a specific index operation, such as esophagectomy. The relationship between surgeon volume and outcomes has potential implications for credentialing of surgeons. Restrictions of privileges based on surgeon volume are only reasonable if there is no substitute for direct experience with the index operation. This study was aimed at determining whether there are valid surrogates for direct experience with a sample index operation-open esophagectomy. The Nationwide Inpatient Sample (2003-2009) was utilized. Surgeons were stratified into low and high-volume groups based on annual volume of esophagectomy. Surrogate volume was defined as the aggregate annual volume per surgeon of upper gastrointestinal operations including excision of esophageal diverticulum, gastrectomy, gastroduodenectomy, and repair of diaphragmatic hernia. In all, 26,795 esophagectomies were performed nationwide (2003-2009), with a crude inhospital mortality rate of 5.2%. Inhospital mortality decreased with increasing volume of esophagectomies performed annually: 7.7% and 3.8% for low and high-volume surgeons, respectively (P < 0.0001). Among surgeons with a low-volume esophagectomy experience, increasing volume of surrogate operations improved the outcomes observed for esophagectomy: 9.7%, 7.1%, and 4.3% for low, medium, and high-surrogate-volume surgeons, respectively (P = 0.016). Both operation-specific volume and surrogate volume are significant predictors of inhospital mortality for esophagectomy. Based on these observations, it would be premature to limit hospital privileges based solely on operation-specific surgeon volume criteria.

Sonography of Zenker Diverticulum

Zenker diverticulum, also known as a pharyngeal pouch, is the most common type of esophageal diverticulum. While sonography is not the imaging modality of choice for diagnosis of a suspected diverticulum, it is not uncommon to detect during a sonographic examination. Typically, a Zenker diverticulum is located in close proximity to the left thyroid gland.

AB017. 94. Case report: surgical management of a large epiphrenic diverticulum

: Oesophageal diverticula are classified by location (pharyngeal, parabronchial or epiphrenic), by pathophysiology (traction or propulsion) and histopathology (true or false diverticula). Epiphrenic diverticula are pulsion diverticula that occur in the distal 10 cm of oesophagus and are associated with oesophageal motility disorders. Oesophageal mucosa and submucosa herniate through the muscular layers resulting in dysphagia, food regurgitation and even aspiration pneumonia. A 63-year-old man was referred with a 1-year history of progressive dysphagia to solids, food regurgitation and halitosis and a recent in-hospital admission with right middle lobe pneumonia. Investigations included a barium swallow, upper endoscopy, and high resolution impedance manometry (HRiM) which diagnosed a right sided epiphrenic diverticulum. HRiM confirmed an oesophagogastric junction (OGJ) outflow obstruction. A thoracoscopic diverticulectomy was performed. In the left lateral decubitus position a 5-port thoracoscopy was performed. Dissection begun by dividing the mediastinal pleura over the oesophagus. The diverticulum was mobilized and the neck of the diverticulum isolated. A 54-Fr bougie was placed into the oesophagus over a guidewire. A longitudinal myotomy was performed distal to the diverticulum to the OGJ to relieve the distal obstruction and prevent recurrence. Once haemostasis was achieved a 16-Fr chest drain and Jackson-Pratt drain were placed and incisions closed in layers. This patient underwent a thoracoscopic diverticulectomy and longitudinal myotomy without complication. A gastrografin swallow on day 3 confirmed an intact staple line and a straight oesophagus.

Esophageal diverticula (excluding cricopharyngeal diverticula)

Diverticula of the middle and lower third of the esophagus are commonly associated with esophageal motility disorders. The increase of intraluminal pressure leads to an outpouching of the mucosal and submucosal layers through the esophageal muscle coat. These pouches are also called false diverticula, because they only consist of the mucosal and submucosal esophageal layers. In contrast, the more rarely encountered true diverticula that retain the complete esophageal wall are generally associated with periesophageal granulomatous lymph node disease. Treatment of both true and false diverticula is generally indicated in symptomatic patients; however, even state of the art minimally invasive surgery is accompanied by considerable perioperative morbidity and should only be performed in carefully selected patients. This aim of this article is to summarize the available scientific evidence and to provide the reader with an updated guide to best clinical practice in the treatment of esophageal diverticula.

Endoscopic Vacuum-Assisted Closure Therapy in Patients with Anastomotic Leakage after Esophagectomy: A Single-Center Experience.

Aim To study the efficacy of E-VAC therapy for patients with anastomotic leakage after esophagectomy. Methods Between January 2013 and April 2017, 12 patients underwent E-VAC therapy for the management of postoperative leakage. Their clinical features and endoscopic procedure details, therapy results, adverse events, and survival were investigated. Results All 12 patients were male and the median age was 57 years (interquartile range 51.5–62.8 years). The reasons for esophageal surgery were esophageal cancer (83.3%), gastrointestinal stromal tumor (8.3%), and esophageal diverticulum (8.3%). Prior to E-VAC therapy, 6 patients had undergone failed primary surgical repair and the median duration from esophagectomy to leakage discovery was 13.5 days (IQR 6–207 days). The median duration of E-VAC therapy was 25 days (IQR 13.5–34.8 days) and the average sponge exchange rate was 2.7 times during the treatment period. After E-VAC therapy, 8 patients (66.7%) had complete leakage closure, 3 (25%) had a decreased leakage size, and 1 (8.3%) was unchanged. The three patients with a decreased leakage size after E-VAC therapy were treated with endoscopic and conservative management without further surgery. Conclusion With proper patient selection, E-VAC therapy is a feasible and safe method for the treatment of anastomotic leakage after esophagectomy.

Two Cases of Thyroid Cancer Associated with Esophageal Diverticulum

Two Cases of Thyroid Cancer Associated with Esophageal Diverticulum

Indications and benefits of intraoperative esophagogastroduodenoscopy.

IntroductionIntraoperative esophagogastroduodenoscopy (IOG) is a diagnostic and therapeutic method for a variety of special conditions in upper gastrointestinal (UGI) pathology. The indication remains individual due to insufficient evidence and limited training of surgeons in digestive endoscopy.AimTo evaluate the indications, benefits and risks of IOG.Material and methodsA single-center retrospective study of 110 consecutive IOGs in 104 patients was performed. The preoperative plan, the timing of IOG, preoperative evaluation, intraoperative finding, localization of the pathology, type of the procedure, change of expected therapy and complications were assessed.ResultsThe cohort comprised 29 esophageal tumors, 5 tumors of the cardia, 36 gastric tumors, gastrointestinal bleeding (8), esophageal diverticula (3), perforations (3), GERD (5), mediastinal pathology (3), fistula (4), assessment of nutrition (10), duodenal adenoma (2), ulcer disease, esophageal stenosis and gastric volvulus. The indication for IOG was established preoperatively in 79% and intraoperatively in 21%. The lesion was localized in 96.4%. The therapy was altered to a wider resection (11), smaller resection (5), localization and surgical therapy of bleeding (8) or allowed minimally invasive surgery (25). A total of 3 postoperative complications included gastric perforation and positivity of resection line (following EMR/ESD) and recurrent bleeding. The 30-day mortality reached 3.6% without a specific cause in IOG.ConclusionsThe IOG is a complementary method in the diagnosis and treatment of UGI pathology. It enables minimally invasive finalization of the procedures and individualization of the therapy.

The difficulties in differential diagnosis of pulmonary thromboembolism in a therapeutic clinic. The rupture of the diverticulum of esophagus, imitating thromboembolism of the pulmonary artery (case from practice)

The difficulties in differential diagnosis of pulmonary thromboembolism in a therapeutic clinic. The rupture of the diverticulum of esophagus, imitating thromboembolism of the pulmonary artery (case from practice)