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Foreign-body-like sensation in proximal esophagus, endoscopy done. What should be the next step ?

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General & Family Physician
Practicing since : 2005
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Prepare a 500 word or more "script" for a health care professional to use when explaining to the patient his condition and the proposed procedures from this II.     II.OPERATIVE REPORT
Date of Procedure: 7/8/20XX
Procedure: Esophagogastroduodenoscopy with foreign body removal.
Preoperative Medication: Demerol 50 mg IV, Versed 3 mg IV, Cetacaine spray
Preoperative Diagnosis:
1. Esophageal foreign body.
2. Odynophagia.
Postoperative Diagnosis: Status-post foreign body removal.
Clinical Note: This is a 47-year-old black male who experienced acute odynophagia after initially eating a meal consisting of fish. The patient felt a foreign-body-like sensation in his proximal esophagus and presented to the emergency room. He was evaluated with lateral, C-spine films, and soft-tissue films without any evidence of perforation. The patient is now referred for evaluation for his proximal esophagus.
Findings: After obtaining informed consent, the patient was endoscoped in the emergency room. He was premedicated with Demerol and Versed without any complications. Under direct visualization, an Olympus Q20 endoscope was introduced orally, and the esophagus was intubated without any difficulty. The hypopharynx was carefully reviewed, and no abnormalities were noted. There were no foreign bodies or lacerations to the hypopharynx. The proximal esophagus was normal. No active bleeding was noted. The endoscope was farther advanced into the esophagus, where careful review of the mucosa revealed no foreign bodies and no obstructions. The distal esophagus did, however, show a very small fish bone, which was removed without any complications. The endoscope was advanced into the stomach, where partially digested food was noted. The endoscope was then removed. The patient tolerated the procedure well, and his post-procedure vital signs are stable.
1. Clear liquids for 24 hours.
2. Follow-up with me in the office in the morning.

Date: 7/8/20XX
Procedure Performed:
Soft-tissue neck. There is a curvilinear density in the region of the base of the tongue that could conceivably represent a small bone. The airway is intact throughout. No other abnormalities are visible.
Date: 7/8/20XX
Admit to Endoscopy Department.
Obtain consent for procedure, signed and witnessed.
Start IV of 55 cc D5W or NS TO KVO or heparin lock.
Preoperative Medications: Versed 3 mg IVP, Demerol 50 mg IVP, apply pulse oximeter.

Posted Sun, 15 Jul 2012 in Ear, Nose and Throat Problems
Answered by Dr. Shanthi.E 2 hours later

Thanks for posting your query. I have read through it carefully.

It seems like a query with academic interest; please do let me know if otherwise.

You may use this script or informed consent for explaining the patient his condition:

We have noted your history and symptoms. It most probably seems like you have a foreign body in your food way or the upper digestive tract.

It is better suggested to get it evaluated radiologically and removed, since you are having odynophagia or a painful throat.

The initial X-rays taken of the neck do not show any confirmatory findings. We would like to proceed further with an upper gastrointestinal endoscopy where in we would like to pass a fiberoptic scope inside your stomach under local anaesthesia and look for any foreign body present there.

If there is a foreign body, we would remove it and you would feel symptom free as we feel there is an oesophageal foreign body and also you have odynophagia or painful throat.

This is a small procedure, it would not cause you any harm. It is done under local anaesthesia. We prefer you get it done.

There is a very very minimal post-operative complication that may arise. The benefit from the procedure is more than the risk involved. The risk- benefit ratio is less here. Please do give us the consent so that we can proceed further.

It is a day care procedure; it should not take more than an hour of your time. You may go back home after the procedure, take clear fluids overnight and XXXXXXX me at my office tomorrow morning.

This is a short paragraph which can be used to explain the patient his condition.

However, it is the operating surgeon's choice to explain to the patient in his own ways.

I hope this helps you.

Please do write back for follow up queries.

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