PMC5447379_01
Chest X-ray and CT.. A: Chest X-ray showed contractile changes in the upper lung fields.. B: CT showed chronic pulmonary inflammation, bronchiectasis, pleural thickness, and left pleural effusion.
gr1.jpg
PMC5447379_01_gr1.jpg
fig0005
Cancer. Chest X-ray showed contractile changes in the upper lung fields (Fig. 1A). CT showed chronic pulmonary inflammation, bronchiectasis, pleural thickness, and a left pleural effusion (Fig. 1B).
Operative findings.. A: Two purse string sutures are applied.. B: Vein stripper is inserted toward the abdomen.. C: Gastroscope is inserted into the esophagus.. D: Stripping is completed.
gr2.jpg
PMC5447379_01_gr2.jpg
fig0010
Two purse string sutures are applied to the proximal edge of the tumor marked by a clip, and the esophagus is detached (Fig. 2A). The vein stripper and the distal stump of the esophagus are affixed firmly (Fig. 2B). After opening a small hole in the anterior wall of the stomach, a gastroscope is inserted into the esophagus (Fig. 2C).
View from the esophageal lumen.. A: Just after the insertion of gastroscope.. B: Esophagus expands after insufflation.. C: Elevated lesion of the esophageal cancer.. D: Cripps of the stump.. E: Start of stripping.. F: Resistance of the stripper can be felt at the non-detached part.. G: Resistance of stripper disappears.. H: The stump of esophagus reachs to the cardia.
gr3.jpg
PMC5447379_01_gr3.jpg
fig0015
After the gastroscope enters the esophagus, the esophagus is easily expanded via insufflation by gently holding traction on the cardia (Fig. 3A,B). The clip is confirmed on the proximal side of the tumor (Fig. 3C,D). The esophageal stump is sequentially inverted under direct visualization (Fig. 3E,F). The resistance of the stripper can be felt on the non-detached part of the esophagus (Fig. 3G). When this resistance disappears, stripping is completed (Fig. 3H).