Patient Develops Life-Threatening Pneumonia After Endoscopy

Case Overview

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.

Questions to the Gastroenterology expert and their responses

Do you routinely treat patients similar to the one described in the case?

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.

Have you ever had a patient develop the outcome described in the case?

I have not had a patient aspirate during endoscopy.

Are there specific precautions needed before performing an endoscopy after a barium swallow?

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, and this is also typically done by the anesthesia provider.

About the expert

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.