GI question

[mizzrazmatazz]

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Is there a good rule for when to do endoscopy vs. barium swallow? I just had a UW question where the guy was having dysphagia with both solids and liquids, 6 lb wt loss, h/o chronic heart burn and the next step in management was barium swallow. Given he had the wt loss and his age (I think he was over 60), I chose endoscopy- can someone explain when to choose barium swallow over endoscopy? The explanation said that all esophageal problems should start with barium swallow but I swear until this question, the answer has always been endoscopy.

Also, with less than a week left, what are FIVE high yield topics that you would definitely review? I am starting to feel burnt out, even though I am far from knowing everything 😱

 

[arthrodisiac]

i think you go straight to endoscopy when there are warning signs with dyspepsia, not necessarily dysphagia. If the guy can't swallow solids or liquids you might not be able to get the endoscope down very far depending on where the stricture or whatever is, so i guess you do barium first. Though, i agree, the answer to this question seems to flip flop throughout the sources. i probably wouldve picked endoscopy too.

as far as high yield, ive said before

pediatric immunodeficiency
trauma
cardiac algorithms...went do u do catheterization vs stress test, etc
look at some derm slides i think, i dunno what else

 

[DrWBD]

Is there a good rule for when to do endoscopy vs. barium swallow? I just had a UW question where the guy was having dysphagia with both solids and liquids, 6 lb wt loss, h/o chronic heart burn and the next step in management was barium swallow. Given he had the wt loss and his age (I think he was over 60), I chose endoscopy- can someone explain when to choose barium swallow over endoscopy? The explanation said that all esophageal problems should start with barium swallow but I swear until this question, the answer has always been endoscopy.

A barium swallow is recommended first not only to rule out obstruction but also to identify WHERE the obstruction is located if there is one present, so that the endoscopist will know what to look for before going in. Also, if there is a Zenker's diverticulum, it can often be seen on the barium swallow, which is also useful to know, as it's very easy to perforate a Zenker's if the endoscopist doesn't know it's there. Barium swallow can also be diagnostic for achalasia - the classic bird-beaking and esophageal dilatation are pathognomonic and would prompt a manometry study. Also, diffuse esophageal spasm is better seen on barium swallow than endoscopy.

However, if the patient had no findings on the barium swallow but persistent symptoms, an upper endoscopy is justified.