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Gastroenterology  (Expert Forum)
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Constant Lump/question on endoscopy § 'balloon'
Answered by
Kevin Pho, MD - Internal Medicine
Kevin, M.D. Boston - MA
This forum is for questions regarding Gastroenterology issues such as Acid Reflux (GERD), Barretts Esophagus, Colitis, Colon/Bowel Disorders, Crohn's Disease, Diverticulitis/Diverticulosis, Digestive Disorders, IBS, Stomach Pain.
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MedHelp Member's Question

Constant Lump/question on endoscopy § 'balloon'

by notsogr8, Mar 16, 2003 12:00AM
About 10 yrs. ago I had an endoscopy done.  I had no anesthesia or sedative except spray on my throat.  It went fine - they found some irritation and treated it.  A few months ago I was having problems with acid reflux so my family doc put me on Nexium for 4 weeks.  It worked great.  But I developed this lump in my throat.  Family doc did a serum h.pylori and it was.25 (fine).  Then he sent me for barium swallow CT scan of abdomen which was clear. So he sent me to a gastroenterologist for an endoscopy.  The GE wants to put me to sleep and do something involving a balloon and stretching.  My questions: 1. is it necessary to be put to sleep?  The first time, I was awake and did fine (different doctor)- this new GE says I have to be asleep so he doesn't poke a hole in my esophagus.  and 2.) How could he know before examining me that I need the balloon thing and is it safe and effective? I am not convinced that it is even my esophagus as my throat and nose burn all the time and my neck (adam's apple) is sore to touch. Any thoughts or suggestions would be welcome.
Doctor's Answer

by Kevin Pho, MD, Mar 16, 2003 12:00AM
Hello - thanks for asking your question.



Please understand my limitations over the internet as I have neither met nor examined you. This information is for patient education only. Please see your personal physician for further evaluation.



Typically a gastroscopy alone is done only with conscious sedation - the technique varies according to the gastroenterologist.  If an esophageal dilation is necessary (you are suggesting that dilation is being considered), then you may need to be sedated for this procedure.  This is dependent on the gastroenterologist.  



Usually endoscopy or a barium swallow is needed to evaluate for any strictures.  It would depend on what is found during endoscopy to see whether you need the balloon dilatation.  Some complications of this procedure include esophageal perforation, bleeding, infection, and aspiration pneumonia.  Studies report the success rate of a dilatation to be between 60 and 90 percent, depending on the cause.  



Followup with your personal physician is essential and strongly suggested.



This answer is not intended as and does not substitute for medical advice - the information presented is for patient education only. Please see your personal physician for further evaluation of your individual case.



Thanks,

Kevin, M.D.

Member Comments (9)

by surgeon, Mar 16, 2003 12:00AM
I'd assume he's considering the possibility that the balloon could be necessary and is preparing in advance. People who have reflux can sometimes develop scar tissue which causes narrowing of the esophagus at a point (stricture) which can be treated with balloon dilataion. He could also just scope you without sedation, etc, and plan a second procedure if necessary; but it makes sense to be ready to do the whole shootin' match at one session....

by ashpie3, Mar 16, 2003 12:00AM
To: notsogr8
Hi, I too am having the same lump sensation and am getting an endoscope on wednesday..I had one done 4 yrs ago and was had the sedative and I think the doctor dilated my throat ..do you have problems swallowing certain things too? I feel like certain things like bread and dry things stick at the bottom of my throat..french fries too..I have been on nexium 2x a day and it's not doing anything for the lump..

by JackieG, Mar 17, 2003 12:00AM
To: Notsogr8
Hi Notsogr8:



I'm not sure if you got your $15 worth from the forum's MD.  It is difficult, as he says, to diagnose over the Internet.



Reflux should not be taken lightly, and difficulty swallowing should be taken very seriously. Your gastroenterologist should perform an endoscopy, and you should be sedated. I say this because the gastroenterologist should be able to see irritation, stricture, etc in the esophageal lining visually through the scope. She/he should be prepared to take biopsies of suspicious looking tissue, and that does hurt without sedation. Your gastroenterologist should NOT be preparing to dilate your esophagus on the first visit. The results of any required biopsies should be known first. It is important to be evaluated. You may have irritation, but you may also have Barrett's Esophagus, low, medium, or high grade dysplasia, or, heaven forbid, esophageal cancer. An accurate diagnosis should be made before a dilation is attempted. If you believe your current gastroenterologist is charging ahead to fast, get the endoscopy/biopsies, and then consider a second opinion.



As for the sedation, many people fear general aneasthesia. They are concerned that they will be put under and suffer a stroke/heart attack, etc.. and not wake up. The procedure your gastroenterologist will be doing is best done with a sedative, but you will not be out. You'll be in a "twilight state", although you may not remember much. They generally use IVs of some combination of valium/demerol/versed, and it is not a risky procedure.



Good luck, and don't fear the sedative. Also, insist on the endoscopy with possible biopsies before deciding on the dilation.



regards,

Chicken Soup

by surgeon, Mar 17, 2003 12:00AM
As was said above, it's not possible to diagnose over the internet: nor is it possible to say what your doctor should or should not do on the first visit. It's going to depend on what is seen.

by GI.PA, Mar 17, 2003 12:00AM
It should be mentioned that some patients benifit from "emperic" dilitation.  Meaning that even though no ring,stricture or other abnormality is seen a dilator or ballon is used.  I have found this to successfully relieve the globus (or lump in the throat) sensation in about 30-40% of my globus patients.  This is most likely what your GI is wanting to do.  It doesnot make sense to do this in two steps.  Talk to your GI about the sedation.  An IV could be started and the procedure attempted awake.  If there are problems or you are uncomforable, sedation can be given and the procedure completed.  



Erin

GI.PA

by notsogr8, Mar 17, 2003 12:00AM
To: ashpie3
Dear ashpie3 - yes, dry things do seem a little harder to swallow.  But it seems I feel fine when I get up in the morning and as the day progresses, the lump is more of an agravation.  Sometimes I wonder if stress has anything to do with it, too??  About the Nexium, I liked it but when I told my family doc about the lump, he told me to stop taking Nexium as it may cause some kind of esophagial lump??? Don't know how that could be.  Best wishes for your procedure Wednesday - I will remember you in my prayers.

by kykatfan, Mar 20, 2003 12:00AM
I too, have the same lump, comes and goes but lately it seems to be there during all waking hours. I also feel extremely tired but I don't know if I just want to sleep because the feeling in my throat bothers me so much.

I had the Barium test, and then had the scope this week, My Dr. said there was nothing abnormal, just Gerd. I have been taking Priosec for about 10 years for Acid Reflux and it does keep the acid from coming up into my throat.

This throat lump started about a month ago when my Dr. switched me from Prilosec to Protonics, I had such a problem with Constipation with Protonics I had to go back to Priolsec.

I don't feel like doing anything, I haven't left the house in weeks except to go to the hospital for tests. Please if anyone has had a successful treatment, tell me.

Thanks, Kaye

by Jeani, Apr 02, 2003 12:00AM
Has anybody out there been on Nexium for a long period of time?  I have been on Prilosec and now Nexium since 1997 and wondering if Nexium could be the cause of my liver enzymes ALT/AST being raised 60/66?  What else is good for GERD that is over the counter or another prescription strength drug that is as good as the PPI's??

by Concerned lady, Apr 07, 2003 12:00AM
Check out these tips. This is a very lengthy posting, but if it helps, it will be worth reading & trying:



Some GASTRIC REFLUX TIPS (without acid blockers):



Please check with your doctor, first, before trying these tips to be sure they are safe, in your particular situation. And, ask child's doctor & pharmacist about adjusting dosages down (tiny fraction of adult dosage), for children.



GER=Gastro-Esophageal Reflux. (Gastro=stomach. Esophagus=food tube.)



LPR= Laryngeal-Pharyngeal Reflux. (Larynx=voice box, containing the 2 vocal cords. Pharynx=throat, above the larynx. The larynx is above the trachea/windpipe.)



Reflux