General oto esophageal evaluation and testing Flashcards
Why should patients with findings concerning for
esophageal diverticulum, complex stricture, or
achalasia undergo esophageal barium swallow
instead of initial endoscopy?
Barium swallow is sensitive for these findings, and these
conditions are associated with a higher risk for esophageal
perforation with endoscopy use.
Is the barium swallow examination always performed using liquid barium?
No. It can be performed with barium tablets or barium-
coated food objects, such as a marshmallow or bread, to identify more subtle lesions.
What is esophageal impedance testing?
This test is performed by a catheter measuring multi-
channel intraluminal impedance, which measures the difference in resistance when a bolus (mucosa, gas, liquid, solid) passes the detecting channels on the device. It can be
used in combination with manometry or pH monitoring and
can identify directionality of bolus movement.
What are the indications for esophageal impedance testing?
● Esophageal dysphasia
● Noncardiac chest pain
● Heartburn or regurgitation
● Preoperative evaluation for antireflux surgery
● Identification of the lower esophageal sphincter before
pH catheter placement
In a patient for whom twice-daily proton pump inhibitor (PPI) therapy has failed and who has a
normal EGD, what test can be performed to
confirm GERD?
Ambulatory esophageal pH monitoring, which may also be
performed to assess adequacy of treatment
What are the two available methods of ambulatory pH monitoring?
Ambulatory pH monitoring entails 24- to 48-hour monitoring of reflux events and clinical symptoms while eating an unrestricted diet with the patient off antacid medication
for at least 7 days. It can be performed via a transnasal
catheter positioned 5 cm above the lower esophageal
sphincter or a capsule attached to mucosa 6 cm proximal to
the Z-line
What main outcome measure is used when evaluating the results of ambulatory pH monitor-
ing?
Percentage of time the intraesophageal pH is < 4, to
distinguish physiologic from pathologic reflux
What endoscopic test allows for evaluation of the oropharynx, esophagus, stomach, and upper
duodenum?
EGD
What test is often recommended as the initial test
for GERD because it provides diagnostic (both visual
and histologic via biopsy) and possibly therapeutic
options to allow stratification of disease?
EGD
Describe three methods for esophageal endoscopy.
● Rigid transoral esophagoscopy performed with the pa-
tient under general anesthesia
● Flexible transoral esophagoscopy performed with the
patient under conscious sedation
● Flexible transnasal esophagoscopy (TNE) performed with
the patient under local and/or conscious sedation
What benefit does endoscopy offer as the first
step in evaluating a patient with esophageal
dysphagia?
Endoscopy can provide visual evaluation and pathologic
tissue samples and can also intervene and provide
therapeutic benefit.
What diagnostic test evaluates both the intraluminal pressures and coordination of the upper esophageal sphincter, esophageal body, and lower
esophageal sphincter?
Esophageal manometry
In a patient with dysphagia, noncardiac chest pain,
or a possible esophageal motility disorder, what
diagnostic test should be considered?
Esophageal manometry
