5. Oesophagus
A. Anatomy, Physiology and Embryology
Objectives: This section teaches the student; the anatomy, physiology, and embryology of the esophagus and the diagnostic tests of normal and abnormal
oesophageal function. During the study of this section;
1. Student learns the anatomy, embryology, innervation, and vascular supply of the esophagus and adjacent structures.
2. Student learns about the physiologic function of the esophagus and pharynx.
3. Student learns the radiographic evaluation of the oesophageal pathologies.
Contents:
1. Anatomy of the esophagus
a. Histology
b. Blood supply
c. Nerve supply
d. Sphincters
e. Muscular composition
f. Mucosa
2. Physiology of the oesophagus
a. Normal peristalsis
b. Hormonal influences
c. Neural influences
3. Assessment of the esophagus
a. Contrast studies
b. Manometry
c. pH studies
d. Radionucleotide scans
e. Endoscopy
f. Esophageal ultrasound
Skills gained: During the training program the resident will acquire knowledge and proficiency in;
1. Interpreting esophageal plain radiographs, contrast studies, CT scans, MRI, and intraluminal ultrasound tests.
2. Orders and interprets manometric and pH studies of the oesophagus.
3. Assists and performs rigid and flexible endoscopy of the pharynx and oesophagus under supervision.
oesophageal function. During the study of this section;
1. Student learns the anatomy, embryology, innervation, and vascular supply of the esophagus and adjacent structures.
2. Student learns about the physiologic function of the esophagus and pharynx.
3. Student learns the radiographic evaluation of the oesophageal pathologies.
Contents:
1. Anatomy of the esophagus
a. Histology
b. Blood supply
c. Nerve supply
d. Sphincters
e. Muscular composition
f. Mucosa
2. Physiology of the oesophagus
a. Normal peristalsis
b. Hormonal influences
c. Neural influences
3. Assessment of the esophagus
a. Contrast studies
b. Manometry
c. pH studies
d. Radionucleotide scans
e. Endoscopy
f. Esophageal ultrasound
Skills gained: During the training program the resident will acquire knowledge and proficiency in;
1. Interpreting esophageal plain radiographs, contrast studies, CT scans, MRI, and intraluminal ultrasound tests.
2. Orders and interprets manometric and pH studies of the oesophagus.
3. Assists and performs rigid and flexible endoscopy of the pharynx and oesophagus under supervision.
B. Congenital Abnormalities
Objectives: This section teaches the student; congenital esophageal abnormalities, that includes oesophageal atresia, tracheo-esophageal fistula and oesophageal
duplications, and performs operative and non-operative management. During the study of this section;
1. Student learns clinical presentations, types, diagnosis and treatment of esophageal atresia and congenital tracheo-esophageal fistula.
2. Student learns clinical presentation and diagnosis of esophageal duplication cysts.
Contents:
1. Oesophageal atresia/tracheo-esophageal fistula
a. Types
b. Clinical presentation
c. Diagnosis
d. Operative and non-operative management
2. Esophageal duplication
a. Histology
b. Clinical presentation
c. Diagnosis
d. Operative management
Skills gained: During the training program the resident will acquire knowledge and proficiency in;
1. Evaluating patients with various types of esophageal tresia/tracheoesophageal fistula and recommends management.
2. Performing and interpreting diagnostic tests of congenital esophageal diseases/
3. Assists and performs in the operative repair of tracheo-esophageal fistula under supervision.
4. Assists and performs the operative management of oesophageal duplication cysts under supervision.
duplications, and performs operative and non-operative management. During the study of this section;
1. Student learns clinical presentations, types, diagnosis and treatment of esophageal atresia and congenital tracheo-esophageal fistula.
2. Student learns clinical presentation and diagnosis of esophageal duplication cysts.
Contents:
1. Oesophageal atresia/tracheo-esophageal fistula
a. Types
b. Clinical presentation
c. Diagnosis
d. Operative and non-operative management
2. Esophageal duplication
a. Histology
b. Clinical presentation
c. Diagnosis
d. Operative management
Skills gained: During the training program the resident will acquire knowledge and proficiency in;
1. Evaluating patients with various types of esophageal tresia/tracheoesophageal fistula and recommends management.
2. Performing and interpreting diagnostic tests of congenital esophageal diseases/
3. Assists and performs in the operative repair of tracheo-esophageal fistula under supervision.
4. Assists and performs the operative management of oesophageal duplication cysts under supervision.
C. Acquired Abnormalities
Objectives: This section teaches the student; various types and causes of acquired abnormalities of the esophagus and their appropriate treatment options. During the study of this section;
1. Student learns the pathophysiology, histology, complications, and diagnosis of esophageal reflux.
2. Student learns the indications for and principles of anti-reflux operations.
3. Student learns varying clinical presentations, methods of diagnosis, and management of paraesophageal hernias.
4. Student learns varying clinical presentations, causes, methods of diagnosis, and treatment of motility disorders of the esophagus.
5. Student learns varying clinical presentations, methods of diagnosis, and management of esophageal perforation.
6. Student learns varying clinical presentations, methods of diagnosis, and management of chemical injuries and trauma of the esophagus.
7. Student learns varying indications, types and operative approaches for esophageal replacement surgical procedures.
8. Student learns varying clinical presentations, methods of diagnosis, and management of esophageal foreign bodies.
9. Student learns varying presentation and management of complications of esophageal operations.
10. Student learns varying etiology, presentations, and management of infections after esophageal injuries and operations.
Contents:
1. Oesophageal reflux
a. Histology
b. Clinical presentation
c. Aetiology
d. Diagnosis
e. Operative and non-operative management
f. Management of complications (bleeding, ulceration, Barrett's mucosa, stricture)
2. Paraesophageal hernias
a. Clinical presentation
b. Diagnosis and indications for operation
c. Operative management
3. Motility disorders
a. Achalasia
b. Scleroderma
c. Spasm
d. Diverticula
e. Clinical presentation
f. Diagnosis
g. Operative and non-operative management
4. Esophageal perforation
a. Etiology
b. Clinical presentation and diagnosis
c. Operative and non-operative management
5. Oesophageal Trauma
a. Chemical injuries
b. Blunt and penetrating trauma
c. Clinical presentation and diagnosis
d. Operative and non-operative management
6. Esophageal replacement
a. Stomach
b. Jejunum
c. Colon
d. Free jejunal replacement
7. Foreign bodies
a. Clinical presentation and diagnosis
b. Methods of removal
8. Video assisted thoracic surgery for esophageal disorders
a. Indications
b. Techniques
9. Oesophageal infections
a. Moniliasis
b. Diagnosis
c. Treatment
10. Rings and webs
a. Diagnosis
b. Treatment
Skills gained: During the training program the resident will acquire knowledge and proficiency in;
1. Interpreting oesophageal plain radiographs, contrast studies, CT scans, MRI, manometry, pH studies, and intraluminal ultrasound examination.
2. Assists and performs esophagoscopy, foreign body removal and biopsy under supervision.
3. Is able to plan various operative approaches to different parts of the oesophagus.
4. Assists and performs anti-reflux operations including management of strictures under supervision.
5. Assists and performs resection and reconstruction using various esophageal substitutes under supervision.
6. Is able to evaluate and plan management of patients with esophageal motility disorders, assists and performs myotomy and resection of diverticula under supervision.
7. Is able to diagnose, plan management strategy, assists and performs operations for esophageal perforation, chemical burns, and trauma under supervision.
8. Is able to manage the complications of esophageal operations.
9. Is able to use and assist video assisted thoracic surgery equipment for esophageal diseases, where appropriate.
1. Student learns the pathophysiology, histology, complications, and diagnosis of esophageal reflux.
2. Student learns the indications for and principles of anti-reflux operations.
3. Student learns varying clinical presentations, methods of diagnosis, and management of paraesophageal hernias.
4. Student learns varying clinical presentations, causes, methods of diagnosis, and treatment of motility disorders of the esophagus.
5. Student learns varying clinical presentations, methods of diagnosis, and management of esophageal perforation.
6. Student learns varying clinical presentations, methods of diagnosis, and management of chemical injuries and trauma of the esophagus.
7. Student learns varying indications, types and operative approaches for esophageal replacement surgical procedures.
8. Student learns varying clinical presentations, methods of diagnosis, and management of esophageal foreign bodies.
9. Student learns varying presentation and management of complications of esophageal operations.
10. Student learns varying etiology, presentations, and management of infections after esophageal injuries and operations.
Contents:
1. Oesophageal reflux
a. Histology
b. Clinical presentation
c. Aetiology
d. Diagnosis
e. Operative and non-operative management
f. Management of complications (bleeding, ulceration, Barrett's mucosa, stricture)
2. Paraesophageal hernias
a. Clinical presentation
b. Diagnosis and indications for operation
c. Operative management
3. Motility disorders
a. Achalasia
b. Scleroderma
c. Spasm
d. Diverticula
e. Clinical presentation
f. Diagnosis
g. Operative and non-operative management
4. Esophageal perforation
a. Etiology
b. Clinical presentation and diagnosis
c. Operative and non-operative management
5. Oesophageal Trauma
a. Chemical injuries
b. Blunt and penetrating trauma
c. Clinical presentation and diagnosis
d. Operative and non-operative management
6. Esophageal replacement
a. Stomach
b. Jejunum
c. Colon
d. Free jejunal replacement
7. Foreign bodies
a. Clinical presentation and diagnosis
b. Methods of removal
8. Video assisted thoracic surgery for esophageal disorders
a. Indications
b. Techniques
9. Oesophageal infections
a. Moniliasis
b. Diagnosis
c. Treatment
10. Rings and webs
a. Diagnosis
b. Treatment
Skills gained: During the training program the resident will acquire knowledge and proficiency in;
1. Interpreting oesophageal plain radiographs, contrast studies, CT scans, MRI, manometry, pH studies, and intraluminal ultrasound examination.
2. Assists and performs esophagoscopy, foreign body removal and biopsy under supervision.
3. Is able to plan various operative approaches to different parts of the oesophagus.
4. Assists and performs anti-reflux operations including management of strictures under supervision.
5. Assists and performs resection and reconstruction using various esophageal substitutes under supervision.
6. Is able to evaluate and plan management of patients with esophageal motility disorders, assists and performs myotomy and resection of diverticula under supervision.
7. Is able to diagnose, plan management strategy, assists and performs operations for esophageal perforation, chemical burns, and trauma under supervision.
8. Is able to manage the complications of esophageal operations.
9. Is able to use and assist video assisted thoracic surgery equipment for esophageal diseases, where appropriate.
D. Neoplasms
Objectives: This section teaches the student; benign and malignant esophageal neoplasms and the various forms of treatment, and performs operative and nonoperative management. During the study of this section;
1. Student learns various types of benign esophageal neoplasms, their clinical presentation, methods of diagnosis, and treatment strategies. (Gastrosurgery)
2. Student learns types of malignant esophageal neoplasms, their clinical presentation, diagnosis, histologic appearance, and treatment options. (Gastrosurgery)
3. Student learns the TNM staging of esophageal cancer. (Gastrosurgery)
4. Student learns the role of chemotherapy and radiotherapy in esophageal cancer. (Radio-Oncology)
5. Student learns the operative approaches, methods, and complications of esophageal resection and reconstruction. (Gastrosurgery)
6. Student learns the indications for operative and non-operative treatment of esophageal cancer. (Gastrosurgery)
7. Student learns the principles of patient management after esophageal resection. (Gastrosurgery)
8. Student learns the nutritional management of patients with esophageal neoplasms. (Department of nutrition)
Contents:
1. Benign esophageal tumors
a. Histology
b. Fibrovascular polyps
c. Leiomyoma
d. Operative and non-operative management
2. Malignant esophageal tumors
a. Histology
b. Squamous cell carcinoma
c. Adenocarcinoma
d. Sarcoma
e. Small cell carcinoma
f. Melanoma
g. Staging
h. Adjuvant treatment
i. Operative management
j. Methods of palliation
Skills gained: During the training program the resident will acquire knowledge and proficiency in the;
1. Evaluation of malignant and benign esophageal tumors and recommends overall management, including neoadjuvant therapy.
2. Evaluation of diagnostic tests for esophageal neoplasms and correlates the results with clinical staging.
3. Assists oesophagectomy through various approaches.
4. Assists reconstruction with various esophageal substitutes.
5. Diagnoses and drawing a management plan in the event of complications of esophageal surgery.
6. Planning and managing the nutritional needs after oesophageal surgery.
7. Assists palliative operations for obstructing esophageal lesions.
8. Discussion of appropriate postoperative or alternate therapy for advanced or recurrent oesophageal diseases.
1. Student learns various types of benign esophageal neoplasms, their clinical presentation, methods of diagnosis, and treatment strategies. (Gastrosurgery)
2. Student learns types of malignant esophageal neoplasms, their clinical presentation, diagnosis, histologic appearance, and treatment options. (Gastrosurgery)
3. Student learns the TNM staging of esophageal cancer. (Gastrosurgery)
4. Student learns the role of chemotherapy and radiotherapy in esophageal cancer. (Radio-Oncology)
5. Student learns the operative approaches, methods, and complications of esophageal resection and reconstruction. (Gastrosurgery)
6. Student learns the indications for operative and non-operative treatment of esophageal cancer. (Gastrosurgery)
7. Student learns the principles of patient management after esophageal resection. (Gastrosurgery)
8. Student learns the nutritional management of patients with esophageal neoplasms. (Department of nutrition)
Contents:
1. Benign esophageal tumors
a. Histology
b. Fibrovascular polyps
c. Leiomyoma
d. Operative and non-operative management
2. Malignant esophageal tumors
a. Histology
b. Squamous cell carcinoma
c. Adenocarcinoma
d. Sarcoma
e. Small cell carcinoma
f. Melanoma
g. Staging
h. Adjuvant treatment
i. Operative management
j. Methods of palliation
Skills gained: During the training program the resident will acquire knowledge and proficiency in the;
1. Evaluation of malignant and benign esophageal tumors and recommends overall management, including neoadjuvant therapy.
2. Evaluation of diagnostic tests for esophageal neoplasms and correlates the results with clinical staging.
3. Assists oesophagectomy through various approaches.
4. Assists reconstruction with various esophageal substitutes.
5. Diagnoses and drawing a management plan in the event of complications of esophageal surgery.
6. Planning and managing the nutritional needs after oesophageal surgery.
7. Assists palliative operations for obstructing esophageal lesions.
8. Discussion of appropriate postoperative or alternate therapy for advanced or recurrent oesophageal diseases.