• Speiseröhrendivertikel
• Refluxerkrankung (Gastro-ösophageale Refluxerkrankung)
• Zwerchfellbruch (Hiatushernie)
• Achalasie
• Speiseröhrenkrebs (Ösophaguskarzinom)

Esophageal Diverticula

Divertikel sind Ausstülpungen der gesamten Wandschichten der Speiseröhre = echte Divertikel bzw. Ausstülpung der inneren Wandschichten der Speiseröhre durch Schwachstellen der Muskulatur = falsche Divertikel. Divertikel der Speiseröhre sind im Allgemeinen eine seltene Erkrankung und treten bevorzugt kurz oberhalb des Speiseröhreneingangs auf (Zenker-Divertikel). Seltener findet man diese Ausstülpungen im mittleren Bereich der Speiseröhre bzw. kurz oberhalb des Zwerchfelldurchtritts (epiphrenische Divertikel).

The incidence of false diverticula increases with age and can be causally attributed to muscular weaknesses due to increased pressure in the esophagus. The cause of true diverticula has not been conclusively determined. Typically, patients with false diverticula frequently report difficulty swallowing, regurgitation of undigested food, bad breath, and coughing.

Treatment of Zenker's diverticulum is performed in our clinic through a small skin incision in the neck area. Here, the diverticulum is removed and the esophageal muscle is partially severed in this area. The latter prevents the recurrence of the diverticulum and is considered an advantage over purely endoscopic procedures. In epiphrenic diverticula, removal of the diverticulum is usually performed using a minimally invasive technique from the abdominal cavity..

Reflux disease (gastroesophageal reflux disease)

Reflux disease is a condition in which there is a pathological increase in the reflux of gastric contents into the esophagus. This normally occurs only rarely and is prevented by a kind of valve between the esophagus and stomach (lower esophageal sphincter). Frequent reflux leads first to irritation, and later to inflammation of the esophagus. At this stage, there is later a change in the mucosal surface (Barrett's mucosa), which is associated with a very high risk of developing esophageal cancer.

Causes of reflux are manifold:

• Hiatal hernia
• Overweight
• weakening of the valve mechanism
• Certain medications
• Alcohol, nicotine
• Increased pressure in the stomach (e.g. emptying disorder)

Patients typically report heartburn, pain behind the breastbone, regurgitation of partially digested food, and irritable cough. These symptoms are often exacerbated in a lying position or by bending over.

Surgery should be considered only in case of failure or intolerance of drug therapy. In addition, a change in lifestyle is important (weight reduction; avoidance of nicotine, coffee, alcohol; small meals; sleeping with the upper body elevated). If the conservative therapy measures have not led to lasting success, or if permanent drug therapy is not possible, surgery may be helpful. For this purpose, a detailed discussion and extended diagnostics are necessary, since not all patients benefit from surgery.

During the operation itself, a minimally invasive technique is used to narrow the usually widened diaphragmatic gap (passage of the esophagus) and to place the upper part of the stomach as a sleeve around the lower sphincter of the esophagus.

Diaphragmatic Hernia (Hiatal Hernia))

A diaphragmatic hernia describes an enlargement of the passage of the esophagus through the diaphragm. Due to the higher pressure in the abdominal cavity there is a
displacement of parts of the stomach into the thorax, rarely a displacement of the entire stomach.

Typically, most patients report reflux symptoms. Obstruction is rare. In very large hernias, anemia may also occur due to irritation of the gastric mucosa.

The operation is similar to that for reflux disease. In most cases, narrowing the enlarged opening of the diaphragm with sutures using minimally invasive techniques is sufficient. Less frequently, if the tissue is very weak in muscle, a plastic mesh must be inserted for support.

Achalasia

Achalasia is a muscular disorder of the esophagus. In this case, there is a lack of relaxation of the lower esophageal sphincter and later a disturbance of the mobility of the entire esophagus with a widening of the muscular tube. The cause is possibly a destruction of the nerve cells or nerve tracts.

Achalasia is a rare disease of early adulthood and manifests as difficulty swallowing, pain behind the sternum, bad breath, reflux of undigested food, and coughing. Many patients lose weight unintentionally due to this problem.

Non-surgical therapies attempt to reduce the increased muscle tension of the lower sphincter. Alternatively, an attempt can be made to dilate the constriction in the course of a gastroscopy. Unfortunately, the success of these conservative measures is often limited in time.

If conservative therapy fails, the lower esophageal sphincter is cut using a minimally invasive technique. A gastric sleeve is then placed around the lower part of the esophagus (see reflux surgery) to prevent the stomach contents from flowing back.

Esophageal cancer (esophageal carcinoma)

Esophageal cancer is a malignant disease of the esophagus, which is one of the most common cancers of the gastrointestinal tract and is diagnosed more frequently in men. Two types of cancer are distinguished: squamous cell carcinoma is a disease of the original esophageal mucosa and thus can occur in all sections of the esophagus. Adenocarcinoma of the esophagus is a malignant disease which has increased in frequency in recent years and which occurs almost exclusively in the lower section of the esophagus. It is usually caused by years of reflux, which, through inflammation, leads to transformation of the mucosa of the esophagus (Barrett's mucosa) and finally to the development of cancer.

In addition to reflux (adenocarcinoma), smoking and alcohol, increased intake of hot drinks, nitrosamines and so-called previous diseases (precancerous conditions) - Barrett's esophagus, achalasia, acid and alkali burns, scleroderma - are discussed as causes of esophageal cancer. In the early stages of the disease there are usually no typical symptoms. Later, the narrowing of the esophageal lumen results in difficulty swallowing, a feeling of pressure, and weight loss.

Surgical treatment of esophageal cancer alone is limited to early stages of the disease. Careful diagnostics can be used to assess the extent of the disease prior to treatment. If an advanced stage has been diagnosed after completion of the examinations, pre-treatment (chemotherapy alone or combined radiation/chemotherapy) is usually necessary. The goal of this pretreatment is to reduce the size of the cancer for subsequent surgery and to improve the long-term prognosis. The decision regarding the treatment strategy is made in our clinic for each patient in a joint tumor conference with the appropriate specialists from pathology, internal medicine, oncology, radiotherapy. The goal is to determine the optimal therapy for each patient according to the tumor stage.

During the operation itself, the diseased esophagus with the adjacent lymph nodes is partially or completely removed. To restore the passage of food, the stomach is usually reduced in size in the form of a tube and connected to the rest of the esophagus. Alternatively, part of the colon can be used. Parts of this operation are also offered in our clinic using minimally invasive techniques.

If, due to the stage of the tumor (e.g., presence of daughter tumors), surgical removal of the cancer is not advisable, the use of stents (tubes made of wire mesh) can eliminate the narrowing of the esophagus to ensure the passage of food. Subsequently, a decision is made on further palliative therapy (tumor conference).