PREPROCEDURE DIAGNOSIS: Dysphagia, probably esophageal dysmotility.
POSTPROCEDURE DIAGNOSIS: Dysphagia, probably esophageal dysmotility.
PROCEDURE PERFORMED: Esophagogastroduodenoscopy with injection of Botox in the mid and distal esophagus.
INDICATIONS: This 42-year-old male was evaluated for conscious sedation and was found to be a candidate.
MEDICATIONS USED: Under my supervision the patient got during the procedure Hurricaine for local anesthesia of the pharynx, fentanyl 100 mcg and Versed 7 mg.
DESCRIPTION OF PROCEDURE: The patient was kept in the left lateral decubitus position. An Olympus panendoscope was advanced without difficulty into the esophagus, which looked normal. No ulcers or masses were seen. The GE junction was identified at 40 cm from the incisors. The panendoscope was advanced into the stomach. The fundus, body and antrum looked normal. No ulcers or masses were seen. The pylorus was identified and did not look deformed. The panendoscope was advanced into the duodenum. The mucosa looked normal. No ulcers or masses were seen. We withdrew the panendoscope into the distal esophagus, approximately 1-2 cm above the GE junction. We started injecting 1 mL of normal saline with 10 units of Botox 1 cm apart, traveling proximally for a total of 100 units of Botox. The patient tolerated the procedure.
PLAN: Will follow the patient in a few weeks in the office.