Esophagoscopy is an endoscopic examination of the esophagus using a flexible fibroscope (less often a rigid esophagoscope) – an optical device inserted through the mouth. As planned, esophagoscopy is performed for various diseases of the esophagus in order to establish the cause of the pathology and conduct differential diagnosis. Emergency manipulation is performed for vital indications. The diagnostic procedure is performed to confirm or exclude a tumor, scar deformity, functional stenosis, diverticula, varicose veins of the esophagus, as well as to take a biopsy. In some cases, esophagoscopy is therapeutic or diagnostic in nature, it is used to stop esophageal bleeding, remove a small tumor, and augment.
The first device for conducting esophagoscopy was designed in the early XIX century (1807) by the Italian doctor F. Bozzini. However, the ancestor of modern esophagoscopy is considered to be the German surgeon I. Mikulich, who in 1887 created an endoscopic tube with internal illumination. Currently, esophagoscopy is used everywhere. The relevance of the study is determined by its diagnostic value, the possibility of performing the procedure on an outpatient basis, and low invasiveness. The combination of accessibility and high information content of esophagoscopy makes it the method of choice for gastroenterologists, oncologists, surgeons and pediatricians at the stage of diagnosis, determining the scope of surgery or in urgent conditions.
An alternative to esophagoscopy is X-ray diagnostic methods or MRI, which allow to determine the location and prevalence of pathological changes. Radiography is used to detect foreign bodies, tumors, developmental abnormalities and strictures of the esophagus. X-ray cimography makes it possible to examine the peristalsis of the organ and determine its violations. CT and MRI are used to study the topography of the esophagus. Vascular pathology and patency of the organ are evaluated with contrast enhancement.
Unlike X-ray examinations, esophagoscopy does not involve radiation exposure to the patient, allows for a direct visual examination of the esophageal mucosa, taking material for a biopsy or simultaneously carrying out therapeutic measures (if necessary). Esophagoscopy does not require the introduction of contrast, which is often necessary for radiography, CT and MRI. The disadvantages of the method are its invasiveness, discomfort of the patient during the procedure and the risk of complications, in particular, perforation of the organ in violation of the technique of manipulation or cicatricial changes in the esophageal wall. Manipulation is impossible with a pronounced narrowing of the organ of any genesis.
The procedure is carried out on a planned or emergency basis. Planned esophagoscopy is performed in the presence of unspecified or undetectable by other methods esophageal disease, suspected tumor, to clarify the prevalence of the pathological process, to assess the effectiveness of previous treatment. Manipulation is carried out with achalasia of the cardia, in order to determine the degree of narrowing of the esophagus as a result of scarring after a chemical burn. The endoscopic procedure makes it possible to detect diverticula, developmental abnormalities, esophagitis, ulcerative process (including localization, prevalence, severity), gastroesophageal reflux. During the study, if necessary, a biopsy is performed. For therapeutic purposes, esophagoscopy is used for the removal of polyps, the introduction of sclerosing drugs, the selection of the size of the bougie for the correction of strictures, the opening of an abscess, laser therapy. Urgent esophagoscopy is more often performed for therapeutic and diagnostic purposes, it is carried out to clarify the nature of emergency pathology, extraction of a foreign body, elimination of food blockage, stopping bleeding.
In emergency situations, there are no contraindications, except in cases when esophagoscopy may be associated with a risk to the patient’s life (in acute myocardial infarction, cerebral stroke, mediastinitis and some other conditions). In other cases, the possibility of performing the procedure is determined by the severity of the patient’s general condition and local changes. Esophagoscopy is absolutely unacceptable if it is impossible to introduce a fibroscope due to narrowing of the esophagus, burns, phlegmon. Manipulation cannot be performed with a large aortic aneurysm. Relative contraindications are pronounced curvature of the vertebral column, severe pathology of the cardiovascular system, pulmonary insufficiency, large goiter, varicose veins of the esophagus, blood clotting disorders, mental disorders.
Preparation and methodology of conducting
Preparation begins in the evening. The patient is prescribed sedatives, it is recommended to refuse dinner and limit the amount of fluid. Esophagoscopy is performed on an empty stomach, usually in the morning. Half an hour before the introduction of the fibroscope, atropine is injected at a dosage appropriate to the age of the subject. At the initial stage, local anesthesia is carried out with a solution of dicaine or another anesthetic through a spray gun. Manipulation is performed in a sitting position, lying on your back or on your side on a special manipulation table with moving parts. The patient’s head and torso are positioned so that the mouth, pharynx and esophagus are in the same plane. The fibroscope is promoted under constant visual control, gradually bypassing the anesthetized root of the tongue and epiglottis. The reference point is the back wall of the oropharynx. It is most responsible to conduct the tube through the pulp between the oropharynx and the esophagus, which is a slit located frontally and opens only at the moment of swallowing.
When moving along the esophagus, air is pumped through the fibroscope so that it is possible to smooth out and examine the folds of the mucous membrane of the cervical organ. The cessation of esophageal resistance to air indicates that the fibroscope enters the thoracic esophagus, devoid of folds. With further movement, a second esophageal pulp is located in the path of the device – the place of its passage through the diaphragm, which is an annular constriction with a slight expansion under it. Bypassing the “ring”, the fibroscope enters the abdominal part of the esophagus, which does not resist air due to the lack of folding and looks like a funnel with a bottom represented by a pulp at the junction of the esophagus into the stomach. Visualization of the mucosa is possible both with the introduction and with the removal of the fibroscope. The device during esophagoscopy should not be inserted to a depth exceeding 15 cm in children and 45 cm in adults. There is also retrograde esophagoscopy, during which a fibroscope is inserted into a gastrostomy. At the same time, the doctor constantly monitors the movement of the fibroscope along the axis of the esophagus with a clearly visible lumen. The most serious complication of esophagoscopy is perforation of the organ wall, requiring immediate surgical intervention.
The absence of pathological changes during esophagoscopy is interpreted as normal. When detecting violations of the integrity of the esophageal wall of varying degrees of severity, changes in color, folding and mobility of the mucosa, rigidity of the walls that do not straighten when air is injected, the revealed pathological changes are described in conclusion. The results of the study are recorded in the outpatient card or medical history. If there is a pathology, the patient needs to contact his or her doctor to make a diagnosis and determine a treatment plan.