MRCP2-2049
A 55-year-old man presents with recurrent episodes of dysphagia to solids and fluids, resolving completely after 2 weeks. This is his fourth episode in 6 months. He reports weight loss of over two stones since the problem started and is fearful of further oral intake in case he vomits up any food he tries to ingest. He denies haematemesis or melaena.
His past medical history includes angina, for which he currently takes minimal doses of GTN. He stopped taking isosorbide mononitrate prescribed to him by his cardiologist as it caused unbearable headaches. His mother died of pancreatic cancer and his uncle recently had an anterior resection for sigmoid colonic carcinoma.
His GP initially improved his swallowing symptoms with nifedipine but they now have no effect. An OGD was unable to pass an obstruction at the proximal oesophagus. A barium swallow demonstrated a ‘corkscrew appearance’. What is the most appropriate next step in management?