Question 1

Difficulty Swallowing with Normal Upper Endoscopy

Accepted Answer

A 38-year-old man began experiencing difficulty swallowing solid food. An upper gastrointestinal endoscopy did not reveal any evidence of intrinsic esophageal obstruction, but the difficulty in swallowing persisted. Ten months later, evidence presented of a mass in the proximal esophagus. The doctor discovered that the mass was due to a thyroid cancer that extrinsically compressed the esophagus, as well as invaded it. At issue in this case was if there was no intrinsic obstruction of the esophagus, should the gastroenterologist have explored the possibility of an extrinsic compression.

Question 2

Time of Diagnosis for Colon Cancer

Accepted Answer

On multiple occasions, a physician examined a 54-year-old woman whose mother had a history of colon cancer. They evaluated symptoms of constipation, abdominal pain, rectal bleeding, and iron-deficiency anemia. She was discovered to have rectal cancer ten months later. Dr. Roland was asked to evaluate whether this diagnosis was given in an adequately timely manner.

Question 3

Colon Cancer After Initial Normal Colonoscopy

Accepted Answer

A 55-year-old man underwent a colonoscopy due to occasional episodes of bright red rectal bleeding. The procedure revealed no abnormalities apart from internal hemorrhoids. Two years later, he was diagnosed with colon cancer. The question in this case was whether a precursor polyp had been present but undetected during the initial colonoscopy, or whether it developed afterward.

Question 4

Inadequate Prep Before Colonoscopy; Colon Cancer Discovered

Accepted Answer

A 53-year-old man, with a prevalent family history of colon cancer, had multiple colonoscopies. The colon was described as “poorly prepped” during a number of these procedures. Twenty months after the last procedure, which was also poorly prepped, a colon cancer was discovered. At issue was whether the tumor was obscured because of the incomplete preparation, whether the diagnosis could have been made earlier, and whether doing so would have made a difference.

Jane Roland, MD, FACG, AGAF

Case Descriptions

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