{"type":"rich","version":"1.0","provider_name":"Transistor","provider_url":"https://transistor.fm","author_name":"Board Pearls","title":"Chapter 1, Ep 3 of 3: Post-surgical and Systemic Dysphagia","html":"","width":"100%","height":180,"duration":618,"description":"These patients carry a surgical or systemic history the EGD report was\nnever built to surface. The connecting principle is simple: the\ndiagnosis lives outside the scope findings, so the job is to ask the\nquestion that reveals it and to read post-surgical anatomy on a barium\nswallow before an endoscopy.\n \nThe case. A patient with severe reflux and dysphagia has absent contractility on\nnearly every swallow and a hypotensive lower esophageal sphincter. The\nreflux looks like the dominant problem. Should you offer an antireflux\noperation?\n \nTopics covered\n\nPost-fundoplication dysphagia: slipped, tight, and telescoped wraps each map to a next move\nBarium swallow first after fundoplication: it shows wrap geometry the EGD cannot reconstruct\nSleeve gastrectomy: incisura stricture and worsened reflux, not relief\nRoux-en-Y as the antireflux bariatric operation; anastomotic stricture and marginal ulcer\nScleroderma: absent distal contractility plus a hypotensive LES, the cleanest fingerprint\nScleroderma reflux is a pump failure, so fundoplication fails; aggressive PPI instead\nSjogren: dysphagia from lost salivary lubrication and a refractory-reflux clue\nAmyloid: infiltrative fibrils, macroglossia as the AL hint, treat the underlying process\nNeuromuscular dysphagia: ALS, myasthenia (fatigable), polymyositis and dermatomyositis\nDermatomyositis carries a malignancy association warranting age-appropriate screening\nChemoradiation: acute mucositis and late fibrotic stricture managed with dilation\n\n \nKey decisions\n\nPost-fundoplication or post-bariatric dysphagia is read first on a barium swallow, not an EGD: geometry drives the diagnosis\nThe tight wrap gets early pneumatic dilation; the slipped wrap gets PPI for its recurrent reflux, with revision for dilation failure\nScleroderma physiology (failed peristalsis plus open LES) means fundoplication fails: the pump cannot push a bolus past a wrap, so treat reflux medically\nSleeve gastrectomy worsens reflux, so Roux-en-Y is the...","thumbnail_url":"https://img.transistorcdn.com/-FuAdDBcPDLhEoUmroZKtOBRvuBn_FHPpYlh41hOnU4/rs:fill:0:0:1/w:400/h:400/q:60/mb:500000/aHR0cHM6Ly9pbWct/dXBsb2FkLXByb2R1/Y3Rpb24udHJhbnNp/c3Rvci5mbS9iNzlh/ZTU4Y2MzNWExMjQ5/MjA5OWMwMmI3ZTk5/NGFiZS5wbmc.webp","thumbnail_width":300,"thumbnail_height":300}