Endoscopy Case Study

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REASON PROCEDURE: Endoscopy. INDICATIONS Recurrent esophageal stricture. Patient with personal history of stage I adenocarcinoma of the esophagus in the setting of Barrett's esophagus, diagnosed elsewhere. He has a history of a distal esophagectomy with a gastroesophageal reanastomosis performed at or near 09/2016. The patient at one point, had a tracheostomy which has been removed. At one point, a feeding jejunostomy tube that has been removed. He has recurrent dysphagia and previous endoscopic dilatation. He presents today for a repeat endoscopy with probable dilatation of the EG junction. PROCEDURE IN DETAIL Timeout was called. Consent signed. IV sedation administered. The forward-viewing endoscope was passed into the esophagus without difficulty. I was able to advance the scope without obstruction through the neo gastric esophageal anastomosis. There is slight narrowing seen, nonobstructive. The stomach was entered and at that point, I found residual food contents. The pylorus was located…show more content…
No ulcer or erosion. No pathology was obtained. Stomach: There was residual semi-digested food within the gastric antrum. There was deformity to the gastric anatomy likely due to his surgery. There was no obstruction to gastric outlet likely delayed emptying is functional. No gastric mucosal lesions were seen. The esophagogastric junction was located 30 cm from the incisors. There was evidence of edema, a slight stricture which is nonobstructive, and a benign-appearing ulceration indicative of ongoing acid reflux. The esophagogastric junction was dilated to a maximum achieved today a 15 mm which should prove adequate for food advancement. Blood loss was minimal. I also biopsied the EG junction ulcer. This appears benign. Biopsies were obtained to rule out malignancy. The more proximal esophagus was normal. The EG junction lies 30 cm distal to the incisor teeth. The procedure then was
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