Investigations | Potential results | Clinical management plan |
---|---|---|
Actions from history, medication and dietary assessment | ||
History findings | History of (partial) gastrectomy or oesophagectomy |
|
Rumination (regurgitation with no obvious cause) |
| |
First line | ||
OGD | Oesophageal stricture | See the guidance in tables 14 and 16. |
Malignancy/tumour recurrence | Refer to appropriate MDT requesting an appointment within 2 weeks. | |
Barium swallow | Pharyngeal pouch | Refer to ENT team. |
Oesophageal stricture | See the guidance in tables 14 and 16. | |
Delayed emptying |
| |
Oesophageal spasm/motility disorder |
| |
Second line | ||
US/CT/MRI/PET | Malignancy/tumour recurrence/lymphadenopathy | Discuss and refer urgently to the appropriate cancer MDT requesting an appointment within 2 weeks. |
Consider also
| These are emergencies. Refer to upper GI surgical team | |
Mesenteric ischaemia | This is an emergency. Discuss with the on-call surgical team immediately. | |
Ascites | Discuss with the supervising clinician and the oncology team within 24 hours. | |
Third line | ||
If normal investigations/no response to intervention | Reassure. |
ENT, ear, nose and throat; GI, gastrointestinal; H2, histamine receptor 2; MDT, multidisciplinary team; OGD, upper GI endoscopy (oesophago-gastroduodenoscopy); PET, positron emission tomography; PPI, proton pump inhibitor; SIBO, small intestinal bacterial overgrowth; US, ultrasound.