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Mean survival time of patients with malignant dysphagia is longer with covered than with uncovered stents. In addition to treating strictures, covered metallic stents also are effective in treating inoperable malignant perforations and tracheoesophageal fistulas. Both covered Wallstents and Gianturco stents are popular. A contrast study shortly after the procedure evaluates stent position with respect to the fistula. Therapy with Wallstent endoprostheses or Gianturco stents of esophagorespiratory fistulas or perforations in patients with unresectable esophageal cancer led to closure of 90% of fistulas and all perforations (75).

Imaging findings tend to be nonspecific. Diffuse Esophageal Spasm Often called nutcracker esophagus, diffuse esophageal spasm is a primary esophageal motor disorder and is a cause of noncardiogenic chest pain. Dysphagia is common. The exaggerated and disordered esophageal contractions are familiar to most radiologists. Compared to manometry, videoesophagography achieved a sensitivity of 100% in diagnosing diffuse esophageal spasm, whereas the sensitivity for scintigraphy was 67% (103). Computed tomography reveals smooth, symmetric, circumferential esophageal wall thickening involving the distal two thirds (108); the periesophageal fat is normal in appearance.

Bile and pancreatic juice reflux have also been implicated. No significant association exists between H. pylori infection and carcinoma of the gastroesophageal junction; this is in distinction to a significant association between H. pylori infection and other gastric adenocarcinomas. Prevalence of esophageal and gastric cardia adenocarcinoma is increasing in the Western world. Data from the Surveillance, Epidemiology, and End Results (SEER) study in the United States reveal that in white males the incidence of esophageal adenocarcinoma increased >350% since the mid-1970s and currently surpasses squamous cell carcinoma (57); an increase also occurred in black males but was considerably lower.

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