ENT Fails To Diagnose Esophageal Cancer In Patient With Persistent Dysphagia

ByWendy Ketner, M.D.

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Updated onSeptember 27, 2018

ENT Fails To Diagnose Esophageal Cancer In Patient With Persistent Dysphagia

This case involves an elderly female patient with a long history of acid reflux who presented with difficulty swallowing. She was referred to an ENT who ordered a barium study for dysphagia. The study showed reflux but no abnormalities and the patient was prescribed Esomeprazole. After a few months on the medication with no improvement, the ENT recommended an esophagoscopy and direct laryngoscopy, which showed no evidence of a tumor. Following the procedures, the patient continued to have nausea episodes while eating. The patient decided to see a GI who recommended an esophagogastroduodenoscopy (EGD). The test showed severe obstruction and firm narrowing at the gastroesophageal junction. A biopsy was taken at this time and revealed esophageal carcinoma stage IV.

Question(s) For Expert Witness

1. Should a patient be referred to GI instead of ENT if they have a long history of acid reflux and difficulty swallowing?

2. Should an ENT have an understanding that exams would not properly evaluate gastroesophageal juncture and in what instances should an ENT either refer to a GI or evaluate the possibility of esophageal cancer?

Expert Witness Response E-052665

inline imageEither ENT or GI is an appropriate place to begin evaluation of swallowing complaints - I can't fault the choice of one over the other. MBS is actually a reasonable "first pass" at ruling out mass lesions of the esophagus. Acuity of further work-up such as esophagoscopy/EGD depends on nature and severity of the dysphagia, which is not well characterized above - mild sense of effortful swallowing with stable weight, no hematemesis, and no odynophagia is not nearly as concerning, for instance, as a case which included sense that foods were mechanically sticking or a case that included any of the 'danger' signs of weight loss, odynophagia, or hematemesis. With this in mind, it seems that work-up from MBS to ENT Esophagoscopy to GI EGD proceeded in fairly short order, all things considered - unless the patient had a very, very strong history of the 'danger signs' as listed above, it does not seem that things were delayed. Keep in mind, most reflux patients with mild dysphagia don't even need EGD - again, depending on the severity of the reflux and severity of the dysphagia. Most esophageal cancers are diagnosed as advanced stage tumors.

About the author

Wendy Ketner, M.D.

Wendy Ketner, M.D.

Dr. Wendy Ketner is a distinguished medical professional with a comprehensive background in surgery and medical research. Currently serving as the Senior Vice President of Medical Affairs at the Expert Institute, she plays a pivotal role in overseeing the organization's most important client relationships. Dr. Ketner's extensive surgical training was completed at Mount Sinai Beth Israel, where she gained hands-on experience in various general surgery procedures, including hernia repairs, cholecystectomies, appendectomies, mastectomies for breast cancer, breast reconstruction, surgical oncology, vascular surgery, and colorectal surgery. She also provided care in the surgical intensive care unit.

Her research interests have focused on post-mastectomy reconstruction and the surgical treatment of gastric cancer, including co-authoring a textbook chapter on the subject. Additionally, she has contributed to research on the percutaneous delivery of stem cells following myocardial infarction.

Dr. Ketner's educational background includes a Bachelor's degree from Yale University in Latin American Studies and a Doctor of Medicine (M.D.) from SUNY Downstate College of Medicine. Moreover, she is a member of the Board of Advisors for Opollo Technologies, a fintech healthcare AI company, contributing her medical expertise to enhance healthcare technology solutions. Her role at Expert Institute involves leveraging her medical knowledge to provide insights into legal cases, underscoring her unique blend of medical and legal acumen.

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