In stricture esophagus caused by corrosive poisoning investigation of choice is?
ANSWER: (A) EndoscopyREF: Harrison's 18th ed chapter 292The most sensitive investigation for corrosive stricture is barium swallow, however best / investigation of choice is endoscopyENDOSCOPYEndoscopy, also known as esophagogastroduodenoscopy (EGD) is the best test for the evaluation of the proximal gastrointestinal tract. Modern instruments produce high-quality color images of the esophageal, gastric, and duodenal lumen. Endoscopes also have an instrumentation channel through which biopsy forceps, sclerotherapy catheters, balloon dilators, or cautery devices can be utilized.The main disadvantage of endoscopy is that it usually necessitates the use of conscious sedation with medicines such as midazolam (Versed), meperidine (Demerol), or fentanylThe key advantages of endoscopy over barium radiography are:Increased sensitivity for the detection of mucosal lesionsVastly increased sensitivity for the detection of abnormalities mainly identifiable by an abnormal colour such as Barrett's metaplasiaThe ability to obtain biopsy specimens for histologic examination of suspected abnormalitiesThe ability to dilate strictures during the examination.BARIUM STUDY:The sensitivity of barium radiography for detecting oesophageal strictures is greater than that of endoscopy, especially when the study is done in conjunction with barium-soaked bread or a 13-mm barium tablet. Barium studies also provide an assessment of oesophageal function and morphology that maybe undetected on endoscopy. Hypopharyngeal pathology and disorders of the cricopharyngeal muscle are better appreciated on radiographic examination, particularly with video fluoroscopic recording.The major shortcoming of barium radiography is that it rarely obviates the need for endoscopy Either a positive or a negative study is usually followed by an endoscopic evaluation either to clarify findings in the case of a positive examination or to add a level of certainty in the case of a negative one.
Endoscopy
Barium meal
Pharyngoscopy
X rays
Abdominal Radiography