Esophageal Disease

These are only general guidelines and not meant to replace instructions from a physician. Please talk with your physician about your specific condition.

About The Condition

Your esophagus is the tube that carries food from your mouth to your stomach.Esophageal Disease Diagram

There are several types of esophageal disease:

Diagnostic Testing

A male patient in a doctor's office describes his symptoms.

Esophagogastroduodenoscopy (EGD)

Purpose: An EGD provides a visual inspection of the esophagus, stomach and first part of the small bowel (duodenum). This procedure enables visualization of changes to your esophagus and stomach, such as ulcers, erosions and Barrett’s esophagus, as well as changes to the anatomy.

Description: The EGD is performed in the procedure center at any of our surgical locations. You will be sedated to make you relaxed and comfortable. The procedure is painless and takes approximately 15 to 30 minutes. You will go home the same day.

Risks: Having an EGD involves a small risk of complications including, but not limited to, sore throat, bleeding or perforation (puncture) of the upper gastrointestinal tract. Because of the intravenous sedation, there is a risk of problems with breathing, heart arrhythmias and pneumonia.

Preparation:

Afterwards: Because of the sedation, you will need a driver to take you home.

High Resolution Impedance Manometry (HRIM)

Purpose: High Resolution Impedance Manometry measures pressures and fluid movement in the esophagus. These measurements help us diagnose esophageal motility disorders and are crucial in planning esophageal surgery.

Description: The HRIM procedure is performed in the office. A small flexible catheter (tube) will be placed into your esophagus through your nose. You will be asked to swallow small amounts of salt water 10 to 12 times during the test. The test lasts about 15 to 20 minutes.

Risks: During the esophageal manometry procedure, there is a small potential for nose bleed. Some patients have difficulty with gagging, but with relaxation, most patients can complete the procedure.

Preparation: Your stomach needs to be empty, so you should have nothing to eat or drink for four hours prior to the study.

Afterwards: There will be no sedation, so you may drive yourself to and from the appointment.

24-Hour Esophageal Impedance pH test

Purpose: The 24-Hour Esophageal Impedance pH test evaluates the extent of gastric reflux into your esophagus over a prolonged period of time, typically 24 hours. Sensors on a catheter measure the level of acidity at various levels in your esophagus, as well as the reflux of stomach contents up into the esophagus. It is the most accurate test to document gastroesophageal reflux and is generally our preferred test because it measures acidity at different levels as well as non-acid reflux events.

Description: In the Esophageal Impedance pH test, a small catheter (tube) will be placed into your esophagus through your nose. This catheter is very thin (2mm in diameter) and is connected to a pocket-sized recording device that will hang over your shoulder. The catheter is inserted during an office visit. After you leave our office, you should go about as much normal activity as you can for the 24-hour duration of the test. The tube is connected to a small receiver, so you may not shower during the study. You will need to return to the office the following day (24 hours later) to have the tube removed.

Risks: Patients may experience some irritation and discomfort in the back of their throat during the procedure. More than 90 percent of patients are able to complete the procedure. Rarely, refractory stimulation of the gag reflex may prohibit completion.

Alternatives: In some patients who are unable to complete the test, or in whom more prolonged monitoring is thought to be more beneficial, the Bravo capsule pH test is an alternative.

Preparation:

BRAVO Capsule Esophageal pH Test

Purpose: The Bravo Capsule Esophageal pH Test measures and records the level of acidity (pH) in your esophagus to determine the degree to which you have acid reflux over a 48 to 96-hour period. The Bravo device consists of a capsule about the size of a vitamin pill that attaches to your esophagus, and transmits information wirelessly to a pocket-sized receiver that you carry with you.

Description: The capsule will be put in place with a catheter. The capsule attaches itself to the inside of your esophagus using suction and the introducing catheter is then removed. The Bravo may be placed during an endoscopy procedure while you are under sedation. The receiver is returned to our office after completion of the test. The capsule will dislodge itself in about 3 to 7 days and pass out with the stool.

Risks: Uncommonly, patients will experience chest pain or discomfort due to the presence of the Bravo capsule in the esophagus. Rarely, the capsule will not fall off spontaneously, or food may hang up on the Bravo capsule, and endoscopy may be required to remove the capsule. The manufacturer advises that an MRI not be obtained if the Bravo capsule could still be in the body. If it has been longer than a month, is is ok to proceed with an MRI. If you need an MRI before one month, it is recommended you have an X-ray to evaluate if the Bravo capsule remains. The Bravo capsule will sometimes dislodge prematurely, or not function properly, and need to be reinserted.

Alternatives: 24-hour Esophageal Impedance or Esophageal Manometry is an alternative catheter-based system that provides greater accuracy in general.

Preparation:

Afterwards: If you have been sedated, you will need someone to drive you home.

Esophagram

Purpose: This test provides X-ray imaging of your esophagus and upper stomach, including the anatomy and motility of the esophagus. It is useful in evaluating swallowing problems, as well as reflux, and is frequently obtained to evaluate esophageal and gastric problems.

Description: An esophagram is performed in the X-ray (radiology) department. You will be given a chalky-tasting thick liquid (barium) to drink, and X-rays will be obtained as you swallow.

Risks: A barium swallow is generally a safe test. Allergic reactions to barium are very uncommon, but may occur. Constipation may result from the barium, and sometimes a mild laxative is helpful. Rarely barium may be aspirated into the lungs during the test.

Preparation: There is no preparation needed for an esophagram.

Afterwards: There is no sedation, so you can drive yourself home.

Before Surgery

Surgery

Our surgeons perform open surgery, as well as minimally invasive surgeries, for esophageal disease. Your surgeon will explain your particular procedure in more detail.

Minimally invasive surgery. Minimally invasive surgery is performed with laparoscopy or robot-assisted surgery using the da Vinci Surgical System.

Open surgery. Minimally With open surgery, your physician will make an incision at the site of the abnormality large enough so he or she can see and touch your internal organs while operating.

After Surgery

If you have additional questions, please contact us at 763.780.6699.

Surgeons Who Treat Esophageal Disease

Adrianne L. Bowen, MD

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763.780.6699

Dr. Bowen sees patients at the following clinic locations:

Special Medical Interests:

  • Minimally invasive surgery
  • Robotic procedures
  • Endoscopy
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Jonathan C. Gipson, MD

Call us Today:

763.780.6699

Dr. Gipson sees patients at the following clinic locations:

Special Medical Interests:

  • Gastrointestinal surgery
  • Pancreas and foregut (esophagus and stomach) cancer surgery
  • Complex laparoscopic and robotic surgical procedures, including gastric bypass, gastric sleeve and hiatal hernia
  • Emergency surgical procedures
  • Surgical management of trauma
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Kamrun Jenabzadeh, MD

Call us Today:

763.780.6699

Dr. Jenabzadeh sees patients at the following clinic locations:

Special Medical Interests:

  • Robotic assisted surgery
  • Advanced laparoscopy
  • Reflux disease
  • Achalasia
  • Esophageal cancer
  • Benign and malignant gastrointestinal pathology
  • Colorectal oncology
  • Complex hernias
  • Groin hernias
  • Complex ventral and hiatal hernias
  • Endocrine, such as adrenal, thyroid and parathyroid diseases
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Kourtney L. Kemp, MD

Call us Today:

763.780.6699

Dr. Kemp sees patients at the following clinic locations:

Special Medical Interests:

  • Laparoscopic procedures
  • Endoscopic procedures
  • Endocrine
  • Esophageal
  • Traumatic injuries
  • Complex hernia surgery
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Steven J. Kern, MD

Call us Today:

763.780.6699

Dr. Kern sees patients at the following clinic locations:

Special Medical Interests:

  • Robotic surgery
  • Gallbladder Surgery
  • Hernia Surgery
  • Surgery for Esophageal Reflux
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Matthew K. Kissner, MD

Call us Today:

763.780.6699

Dr. Kissner sees patients at the following clinic locations:

Special Medical Interests:

  • Minimally invasive surgery for hernia repair
  • Complex repair of ventral/incisional hernia
  • Robotic surgery, advanced laparoscopic surgery
  • Colon surgery
  • Thyroid surgery
  • Parathyroid surgery
  • Colonoscopy and upper endoscopy
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Sarah J. Lippert, MD

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763.780.6699

Dr. Lippert sees patients at the following locations:

Special Medical Interests:

  • Minimally invasive surgery
  • Bariatric surgery
  • Advanced esophageal procedures
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Corey J. Stennes, MD

Call us Today:

763.780.6699

Dr. Stennes sees patients at the following clinic locations:

Special Medical Interests:

  • Melanoma
  • Thyroid disease
  • Parathyroid disease
  • Gastric reflux
  • Hiatal hernia
  • Gastrointestinal malignancies
  • Repair of complex hernias
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rachel tay, MD

Call us Today:

763.780.6699

Dr. Tay sees patients at the following clinic locations:

Special Medical Interests:

  • Breast Cancer, breast disease
  • Colon resections
  • Gallbladder disease
  • Hernias
  • Nissen fundoplications
  • Thyroid conditions
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