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[DYSPHAGIA] Esophagectomy

  • Subject: [DYSPHAGIA] Esophagectomy
  • From: rgrabo@capital.net (Diane and Bob Grabo)
  • Date: Tue, 25 May 1999 20:53:01 -0400

Dear Kim,

	In addition to Jan's excellent comments, I would add that if you are
able to conduct an MBS, that you use a "fake" barium pill in the test. 
First do the usual routine of small amounts of thin liquid barium and/or
pureed food to R/O aspiration, obvious problems (i.e. TE fistula), etc. 
Then, if no obvious problems are noted, have him swallow a barium pill
with water and have the Radiologist follow it through the revised
esophagus/stomach.  You might find a point of narrowing.  Then see what
happens if more liquid barium is consumed.  Obviously, proceed slowly
and carefully!  I had a similar case last week and the pill became
lodged at the point of the anatamosis.  Thin liquid and pureed food had
passed through just fine (in small increments presently slowly) but then
the pill was given and it got hung up and impeded the flow of further
intakes of liquid and pureed food.  This gentleman had an EGD performed
yesterday and they found candidiatis as well as edema at the site of the
anasatomosis.  He underwent surgery for a J tube today. The goal will be
to return him to an oral diet when he has had more time to heal (no more
edema, resolution of the infection)  He's actually only a few weeks post
surgery and had initially received nutrition via TPN.  I was called in
to see him last week when the initial attempts to return him to a liquid
diet were unsuccessful.   By the way, the fake pill is designed to melt
after 30 minutes. - Diane Grabo

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