Pre Procedure H&P and Procedure Note:
Pre-Anesthesia Assessment:
-ASA Grade Assessment: III - A patient with severe systemic disease. Patient identification using first and last name and date of birth, and the proposed procedure were verified by the physician and nursing staff. After reviewing and explaining the proposed procedure; the potential risks/side effects; the possible results of not undergoing the procedure and any potential complications or recovery problems and the reasons alternative methods of treatment and their risks and benefits with the patient, the patient agrees with the procedure and wishes to proceed. Informed consent was obtained.
Diagnostic and radiological tests results necessary for procedure are available.
Blood/blood products and any special equipment/implants/devices needed for the procedure were discussed and available. Immediately prior to the procedure I reevaluated the patient and it is safe to proceed and the procedure time out was completed per policy. The Endoiscope was introduced through the mouth, and advanced to the second part of duodenum. Heart rate, respiratory rate, oxygen saturations, blood pressure, pulmonary ventilation adequacy and response were monitored during procedure and physical status was reassessed after the procedure.
Estimated Blood Loss:
Estimated blood loss was minimal.
Findings:
The esophagus and gastroesophageal junction were examined with white light and narrow band imaging (NBI) from a forward view and retroflexed position. There was mucosa of a few mm suspicious for Barrett's esophagus, circumferentially. A small single island of salmon-colored mucosa were present, immediately above the Z-line at 11 o'clock. The maximum longitudinal extent of these esophageal mucosal changes was 2-3 mm in length.
The Halo TTS radiofrequency ablation device was used to ablate the Barrett's mucosa. Energy was applied at 12J per centimeter squared. The island the whole circumferential mucosa, suspicious for Barrett's, was ablated. Standard protocol was used.
A few small sessile fundic gland polyps with no bleeding and no stigmata of recent bleeding were found in the gastric body.
A single xanthoma with no bleeding and no stigmata of recent bleeding was found on the greater curvature of the gastric body.
Localized moderately erythematous mucosa without active bleeding and with no stigmata of bleeding was found in the first portion of the duodenum.
Post Procedure Diagnosis/Impression:
-Suspected Barrett's esophagus of 2-3 mm in maximal longitudinal extent. RFA was performed for the entire circumference of the suspected Barrett's mucosa, including a small island found immediately adjacent to the Z-line.
-A few fundic gland polyps.
-A single xanthoma found in the stomach.
-Erythematous duodenopathy.
-No specimens collected.
Recommendation:
-PPI BID until follow-up endoscopy.
-Antacid/lidocaine mixture PO prn.
-Liquid acetaminophen with or without codeine PO prn.
-Xylocaine swallow for 3 days prn.
-Carafate 1gm four times a day prn.
-Full liquid diet for 24 hours then advancing to soft diet, advance as tolerated.
-Avoid Aspirin or NSAIDS.
-Contact immediately for significant chest pain, difficulty swallowing, fever, bleeding, abdominal pain, difficulty breathing, vomiting or other warning symptoms.
-Repeat upper endoscopy in 3 months for surveillance/retreatment prn.