Demonstration Of Esophageal Varices

Mucosal Inversion and Injection The esophagus should be left attached to the stomach, which should be opened along the greater curvature. A string is tied to the upper end of the unopened esophagus and then pulled through the lumen to evert the esophagus. Varices will shine through the mucosa and are accentuated by subsequent formalin fixation.

The features can be further enhanced by injecting the varices with barium sulfate-gelatin, either directly or after inflating the veins with air. Unless autolytic changes are severe, points of hemorrhage are easily demonstrated by this method. It should be noted that in general, esophageal varices still can be successfully injected and roentgenographs prepared (Fig. 5-1) if the esophagus has not been inverted but opened conventionally, that is, lengthwise. Of course, some leakage must be expected at the free edges of the specimen.

Other Methods Air-drying and clearing techniques (1-3) have been used in the past, primarily to prepare museum specimens (Fig. 5-2). They are probably no longer practiced and shall not be described here further.

DEMONSTRATION OF LOWER ESOPHAGEAL RINGS Lower esophageal rings (Schatzki rings) can be palpated or objectively demonstrated by roentgenography (4). The lower half of the esophagus is removed with the upper half of the stomach and an attached ring of diaphragm. The stomach is clamped across the corpus. The preparation is then filled and slightly distended with a mixture of barium sulfate and 10% formalin solution. Roentgenograms should be prepared as soon as possible after death. Subsequently, the specimen should be fixed in the distended state. We suspend it in a formalin tank until it is to be cut.

This method also can be used for other types of strictures and stenoses of the esophagus.

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