India has a low incidence of gastric cancer. It ranks among the top five most common cancers. Regional diversity of incidence is of importance. It is the second most common cause of cancer related deaths among Indian men and women in the age between 15 and 44. Helicobacter pylori carcinogenesis is low in India. Advanced stage at presentation is a cause of concern. Basic and clinical research in India reveals a globally comparable standard of care and outcome. The large population, sociodemographic profile and challenges in health expenditure, however, remain a major challenge for health care policy managers. The newer formation of National Cancer Grid, integration of national databases and the creation of social identification database Aadhaar by The Unique Identification Authority of India are set to enhance the health care provision and optimal outcome.

A case of post-traumatic retropharyngeal haematoma causing airway obstruction in an elderly man on anticoagulant therapy is described. The importance of managing the airway, cervical spine and haemostatic problem with the help of a multidisciplinary team is discussed.

Background Scleroderma esophagus is a rare entity. Only few case reports of esophagectomy were done and reported for this condition. We are presenting this rare case of failed fundoplication and mesh repair with a diagnosis of GERD and hiatus hernia, which was found later on due to Scleroderma with Esophageal involvement. Methods 58 year old female admitted with dysphagia following laproscopic fundoplication with mesh repair of crura with a diagnosis of GERD and hiatus hernia.She presented with persistent vomiting and loss of weight.On evaluation, her Upper GI scopy revealed dilated esophagus with sluggish peristalisis. Since the patient had tightness of skin over the distal extremities, face and fish mouth appearance with thinning of nail, Skin biopsy was taken. The skin biopsy was reported to be scleroderma.The esophageal manometry demonstrated failed esophageal peristalisis with high normal LES pressure due to tight fundal wrap.The patient was treated with mesh remova, Transhiatal esophagectomy with gastric pull-up and cervical Anastomosis.Post operatively the patient was treated with hydrocholoroquine and predinisolone. Results The patient is free of dysphagia and is on regular follow up. Conclusion In case of failure, detailed evaluation including High resolution manometry (MII HRM) has to be done before doing laparoscopic fundoplication for GERD has to rule out uncommon and rare disorders of esophagus. Detailed clinical examination in GERD patients has to be done to rule out systemic disease like scleroderma.In case of failed fundoplication for GERD, patients have to investigated for the failure.So patients with incapacitating esophageal neuromotor disease, a more radical approach in the form of esophagectomy may be safer and more reliable than attempting another procedure and risk another failure. Disclosure All authors have declared no conflicts of interest.

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Background Stenting of Boerhaave syndrome is accepted as a modality of therapy but may not be successful at all times. We report a case of failed stenting, restenting and TEF due to stent. Methods This patient was managed at a different center and has undergone multiple procedures before. We have listed the procedures in chronological order. 24 FEB 2017: Endoscopy for acute retrosternal pain 28 FEB 2017: Left ICD for pyothorax 4 MARCH 2017: 15cm PTFE covered stent for large oesophageal rent at 28 cm 3 APRIL 2017: Stent removal 4 APRIL 2017: Check CT scan oesophago pleural fistula with 3mm rent on lelft lateral wall 8 APRIL 2017: Fistula closure with APC and fibrin sealant. 12 APRIL 2017: Fistula closure done with Thermal coagulation glue and covered SEMS. 27 MAY 2017: Stent removal and check ct showed supracarinal TEF admitting the scope. REFERED TO OUR UNIT AT THIS STAGE. Results Procedure done at our center: Right thoracotomy, layered fistula closure and vascularised intercostal muscle flap, subtotal esophagectomy, retrosternal gastric pullup, oesophago gastric anastamosis with feeding enteral access. Conclusion Post operative period was uneventful. Tracheostomy was done on 4th POD as there was drop in oxygen saturation. He improved gradually. Oral fuid started on day 7. Discharged on day 16. He is on regular followup.Tracheostomy and jejunostomy tubes removed. He was eating and speaking normally. This case is presented to high light the pertinent issues and limitations of SEMS placement for oeosphageal perforation. Diligent approach is to be followed in cases presenting with large diameter perforations. Caution should be exercised in SEMS exchange procedures when primary stenting has not produced optimal results. Surgery in select situations can be an optimal solution in these patients. Disclosure All authors have declared no conflicts of interest.