Approach to Dysphagia: Esophageal Cancer & Achalasia Cases
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Case1 :
Esophageal Cancer
Diagnosis
Management
Case2 : Achalasia
Diagnosis
Management
Case3 : GERD
Diagnosis
Management
6
5
y
e
a
r
s
o
l
d
c
o
m
p
l
a
i
n
i
n
g
o
f
d
y
s
p
h
a
g
i
a
.
H
o
w
w
i
l
l
a
p
p
r
o
a
c
h
h
i
m
?
History and clinical examination:
onset
duration
site
progression
associated symptoms
Odynophagia
Cough
hoarseness
H
i
s
t
o
r
y
Lymphadenopathy
CBC
CXR
ECG
-
U
p
p
e
r
G
I
e
n
d
o
s
c
o
p
y
Location
Size
Obstructing?
Biopsy
Location
Size
Obstructing?
-
T
N
M
s
t
a
g
i
n
g
b
y
d
o
i
n
g
C
T
(
c
a
p
)
Conservative
Surgical
Adenocarcinoma
Squamous carcinoma
Nutritional status support
Endoscopic dilatation &stenting
TPN
Gastrostomy tube
Chemo radiotherapy
Esophagectomy:
Trans hiatal esophagectomy
Transthoracic esophagectomy
3
0
y
e
a
r
s
o
l
d
c
o
m
p
l
a
i
n
i
n
g
o
f
d
y
s
p
h
a
g
i
a
.
H
o
w
w
i
l
l
a
p
p
r
o
a
c
h
h
i
m
?
H
i
s
t
o
r
y
a
n
d
c
l
i
n
i
c
a
l
e
x
a
m
i
n
a
t
i
o
n
:
Onset
Duration
Site
Progression
Associated symptoms
Unremarkable
Upper GI endoscopy
Bird’s beak or Rat’s tail
Obstructing?
Regular stricture edges
Manometry study:
High LES pressure
Aperstalises
Fail of LES relaxation
Conservative
Surgical
Pneumatic dilatation
Calcium channel blockers
Botulinum toxin injection
Laparoscopy or laparotomy and Heller
myotomy
3
0
y
e
a
r
s
o
l
d
c
o
m
p
l
a
i
n
i
n
g
o
f
h
e
a
r
t
b
u
r
n
a
n
d
r
e
g
u
r
g
i
t
a
t
i
o
n
s
.
H
o
w
w
i
l
l
a
p
p
r
o
a
c
h
h
i
m
?
History and clinical examination:
Onset
Duration
Associated symptoms
Has he treated before
Responding to medications
Unremarkable
Upper GI endoscopy
Barium swallow:
Reflux of the material to the esophagus
Ambulatory 24 h PH monitoring
Demester score >14.7
Conservative
Surgical
Changing life style
PPI
Laparoscopy or laparotomy and Nissen
fundoplication
Esophagitis
Peptic stricture
Barrit esophagus :The most serious one as it
consider as a pre malignancy
(intestinal
metaplasia in the lower esophagus).
This presentation covers the diagnostic approach and management strategies for dysphagia in a 65-year-old patient presenting with symptoms such as odynophagia, cough, hoarseness, and lymphadenopathy. It discusses the use of CBC, CXR, ECG, upper GI endoscopy, CT, and biopsy in assessing the location, size, and obstruction in esophageal cancer. Treatment options include nutritional support, endoscopic dilatation, stenting, TPN, gastrostomy tube, chemo, radiotherapy, and surgical interventions like esophagectomy. A similar approach is depicted for a 30-year-old patient with dysphagia. Images and descriptions accompany each step of the diagnostic and management process.
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Presentation Transcript
Case1 :Esophageal Cancer Diagnosis Management Case2 : Achalasia Diagnosis Management Case3 : GERD Diagnosis Management
65 years old complaining of dysphagia. How will approach him?
onset duration site progression associated symptoms Odynophagia Cough hoarseness
CBC CXR ECG
Location Size Obstructing? Biopsy
Location Size Obstructing?
Conservative Surgical
Adenocarcinoma Squamous carcinoma
Nutritional status support Endoscopic dilatation &stenting TPN Gastrostomy tube Chemo radiotherapy
Esophagectomy: Trans hiatal esophagectomy Transthoracic esophagectomy
30 years old complaining of dysphagia. How will approach him?
Onset Duration Site Progression Associated symptoms
Birds beak or Rats tail Obstructing? Regular stricture edges
Manometry study: High LES pressure Aperstalises Fail of LES relaxation
Conservative Surgical
Pneumatic dilatation Calcium channel blockers Botulinum toxin injection
30 years old complaining of heartburn and regurgitations. How will approach him?
Onset Duration Associated symptoms Has he treated before Responding to medications
Barium swallow: Reflux of the material to the esophagus
Ambulatory 24 h PH monitoring Demester score >14.7
Conservative Surgical
Laparoscopy or laparotomy and Nissen fundoplication
Esophagitis Peptic stricture Barrit esophagus :The most serious one as it consider as a pre malignancy (intestinal metaplasia in the lower esophagus).
