This case involves a middle-aged man who presented to the hospital complaining of difficulty swallowing which had persisted for several hours before he arrived. According to the patient, he had been at a business dinner with several clients when a piece of food became lodged in his esophagus. A chest x-ray revealed the obstruction within the patient’s esophagus, and an endoscopy was scheduled with a gastroenterologist at the same hospital. During the procedure, the patient vomited a substantial quantity of barium that the patient had swallowed earlier in order to obtain images of his esophagus. As a result, the patient developed a severe case of pneumonia, which required an extended stay in the hospital to treat and nearly killed the patient on multiple occasions.
Question(s) For Expert Witness
1. Do you routinely treat patients similar to the one described in the case?
2. Have you ever had a patient develop the outcome described in the case?
3. Are there specific precautions needed before performing an endoscopy after a barium swallow?
Expert Witness Response E-000006
Typically the supervision of CRNA's in the inpatient setting will be done by anesthesia, not GI, but every institution is different. Barium is not typically given when there is a possible impaction/obstruction, as it does lead to an increased risk of aspiration. Typically on cases where there is obstruction, protecting the airway by intubating the patient is standard of care, an this is also typically done by the anaesthesia provider. I am a board certified GI affiliated with an academic health center. I typically treat similar patients, and I do endoscopies on patients with suspected food impaction on a weekly basis. I have not had a patient aspirate during endoscopy. I have regularly performed endoscopy in a hospital endoscopy suite. I will be alone in the room with CRNA's and AA's and will give them orders and instructions, however their supervision is the responsibility of an anesthesiologist.
Expert Bio
This double board certified expert has been practicing for nearly 25 years. Fellowship trained in Gastroenterology, he is a member of multiple prestigious gastrointestinal societies and has been running his own gastroenterological practice for the past 19 years. He is also currently an Assistant Professor of Medicine at a prominent medical school, as well as the Medical Director of the Department of Endoscopy at an academic hospital.
About the author
Wendy Ketner, M.D.
Dr. Wendy Ketner is a distinguished medical professional with a comprehensive background in surgery and medical research. Currently serving as the Senior Vice President of Medical Affairs at the Expert Institute, she plays a pivotal role in overseeing the organization's most important client relationships. Dr. Ketner's extensive surgical training was completed at Mount Sinai Beth Israel, where she gained hands-on experience in various general surgery procedures, including hernia repairs, cholecystectomies, appendectomies, mastectomies for breast cancer, breast reconstruction, surgical oncology, vascular surgery, and colorectal surgery. She also provided care in the surgical intensive care unit.
Her research interests have focused on post-mastectomy reconstruction and the surgical treatment of gastric cancer, including co-authoring a textbook chapter on the subject. Additionally, she has contributed to research on the percutaneous delivery of stem cells following myocardial infarction.
Dr. Ketner's educational background includes a Bachelor's degree from Yale University in Latin American Studies and a Doctor of Medicine (M.D.) from SUNY Downstate College of Medicine. Moreover, she is a member of the Board of Advisors for Opollo Technologies, a fintech healthcare AI company, contributing her medical expertise to enhance healthcare technology solutions. Her role at Expert Institute involves leveraging her medical knowledge to provide insights into legal cases, underscoring her unique blend of medical and legal acumen.
