Esophagoscopy

Rigid esophagoscopy is a frequent surgical procedure that doctors conduct all around the world. This method was first recorded in the fourth century and was linked to sword swallowing. The pioneering work of Adolf Kussmaul and Chevalier Jackson in the 19th and 20th centuries, respectively, is credited with the progress in method and instrumentation. Esophagoscopy is utilized for both diagnostic and therapeutic purposes in the treatment of esophageal disorders. Flexible esophagoscopy has replaced rigid esophagoscopy as the primary method for diagnosing esophageal disorders throughout the last two to three decades. Despite this, rigid esophagoscopy is still very beneficial in the treatment of esophageal disorders, particularly for foreign body removal and complex biopsies.

Transnasal esophagoscopy has surpassed traditional esophagoscopy in the treatment of esophageal problems in advanced countries since the1990s, due to its advantage over traditional esophagoscopy (rigid and flexible).

Where Esophagus Located?

The mediastinum, also known as the center of the chest, is where the esophagus is housed. It is located in front of the spine and behind the trachea.

Esophagus Z Line

The squamocolumnar junction (SCJ), or the transition between the squamous and intestinalized columnar epithelium of the metaplastic segment in cases of Barrett's esophagus, is marked by the Z line.

What is an Esophagoscopy?

An esophagoscopy is a technique in which your doctor uses a long, thin device called an endoscope to inspect the inside of your esophagus. The endoscope has a camera and a light that sends images of the inside of your esophagus to a video screen. Esophagoscopy can be used to identify and treat esophageal diseases and conditions including esophageal cancer, Barrett's esophagus, and objects lodged in the esophagus.

The esophagus is a muscular tube that links your mouth to your stomach in the upper gastrointestinal tract. An esophagoscopy can help your healthcare provider figure out what's causing your unexplained symptoms, such as trouble swallowing, upper abdomen pain, bloody vomiting, or regurgitation. Certain components of the throat and larynx (voice box) can also be seen during an esophagoscopy.

Esophagoscopy is a minimally invasive treatment that is frequently done as an outpatient procedure. There is no need for an incision, and the operation has a rapid recovery time and a low risk of complications.

Esophagoscopy is just one way of treating and diagnosing esophageal problems. To determine which choice is best for you, speak with your physician or healthcare provider about all of your choices.

Types of Esophagoscopy

Rigid esophagoscopy. The doctor introduces a rigid tube into the cervical esophagus through the mouth. The doctor can see the esophagus with the use of an eyepiece and a light in the tube. The rigid esophagoscopy was used to identify head and neck tumors as well as to remove foreign bodies from the cervical esophagus. This treatment necessitates general anesthesia and is rarely performed nowadays.
Flexible esophagoscopy. This is the most common operation, which involves inserting a flexible tube into the upper gastrointestinal tract and passing it through. When compared to rigid esophagoscopy, the micro-camera transmits high-resolution views and presents a lower risk of esophageal laceration. It can be done with or without sedation.
Transnasal esophagoscopy. This procedure involves inserting an ultrathin tube into the esophagus through the nose. This treatment does not involve sedation and is often well tolerated.
Esophageal capsule endoscopy. The patient takes a capsule-sized camera that sends high-resolution images as it goes through the esophagus.

Transnasal and capsule esophagoscopy are useful diagnostic tools, however, they cannot be used to perform surgery or take biopsy samples.

Procedures Done with Esophagoscopy

During your esophagoscopy, your doctor may propose one or more procedures to diagnose or treat certain diseases. During the esophagoscopy examination, the following procedures may be conducted:

Injection of botulinum toxin into the lower esophageal sphincter to improve difficulty swallowing caused by a hypertensive lower esophageal sphincter.
Chromoendoscopy is a procedure in which spraying dye is injected into the esophagus to identify diseased tissue.
Dilation of the narrow esophagus caused by scar tissue formation (stricture)
The use of drugs to decrease esophageal varices is known as endoscopic injection treatment (enlarged veins in the esophagus that can bleed)
In early-stage esophageal tumors or Barrett's esophagus, endoscopic mucosal resection (EMR), which is the excision of aberrant lesions with an endoscope, can be performed.
Fluorescence spectroscopy is used to identify malignant esophageal tissue.
Removal of foreign bodies, as well as a food or other objects lodged in the esophagus
With a laser delivered through an endoscope, photodynamic therapy is used to treat esophageal malignancy.
Barrett's esophagus is treated with radiofrequency ablation (RFA), which uses heat to eradicate abnormal cells.
Tissue biopsy is a procedure in which abnormal-looking intestinal tissues are removed and analyzed for disease or cancer.
The treatment of esophageal varices by variceal ligation (tying the dilated diseased vessels with elastic bands).

Esophagoscopy Indications

An esophagoscopy may be recommended by your doctor to diagnose and possibly treat a range of diseases and problems of the esophagus, throat, and larynx (voice box). These are some of them:

Acid reflux, gastroesophageal reflux disease (GERD), hiatal herniation, laryngopharyngeal reflux, or heartburn.
Barrett's esophagus is a condition in which stomach acid destroys the lower part of the esophagus.
Neck, throat, airway, or esophagus cancer, tumor, or mass.
Chronic cough or hoarseness caused by diseases such as GERD and acid reflux.
Dysphagia (difficulty swallowing), odynophagia, and esophageal motility problems, such as hypertensive lower esophageal sphincter, or trouble feeding and regurgitation in babies.
Esophageal varices are bulging, bleeding veins in the esophagus.
Evaluation and removal of foreign bodies.
The globus sensation is a sensation of a lump in the throat.
Scar tissue or a muscle disease can restrict or compress the esophagus, causing it to narrow or collapse.
Esophageal trauma such as a tear or injury caused by forceful and repetitive coughing or vomiting
Vomiting blood as a result of a bleeding ulcer in the upper gastrointestinal tract or esophageal veins.

Who performs an Esophagoscopy?

Esophagoscopy is routinely performed by the following specialists:

Gastroenterologists. Internists specialize in gastrointestinal tract illnesses.
Pediatric gastroenterologists. They are doctors that specialize in the diagnosis and treatment of digestive and nutritional issues in children.

Esophagoscopy is also performed by the following specialists:

General and pediatric surgeons. They are skilled at treating a wide range of diseases, problems, and conditions via surgery.
Otolaryngologists and pediatric otolaryngologists. They are specialists in ear, nose, and throat problems. They're also known as ENTs.

Esophagoscopy Preparation

You're not alone if you dread the prospect of having an esophagoscopy performed. You're an important part of your own medical team. The preparations you make before your treatment will help you feel more at ease and have a better outcome. You can prepare for an esophagoscopy by doing the following:

Answering all questions regarding your medical history and current drugs. Prescriptions, over-the-counter medications, herbal therapies, and vitamins are all included. A current list of your health conditions, medications, and allergies should be brought with you at all times.
Following all of your doctor's detailed instructions to the point. This usually entails avoiding eating or drinking for four to eight hours before the surgery. You may also have to take a pill to dry up your mouth and airways before the procedure.
You will need to remove your dentures for the operation if you wear them. Leaving children with a family member or at home, if possible, is a smart idea.
Taking or discontinuing drugs according to the instructions. This may include avoiding aspirin, ibuprofen, and blood thinners before an esophagoscopy. Your doctor will give you detailed advice on how to take or stop taking your drugs and supplements.

It might be stressful to prepare for an esophagoscopy. During a doctor's visit, it's usual for patients to miss some of their concerns. After your appointment, you may have more questions. Before the procedure and in between consultations, contact your health care provider if you have any concerns or questions.

Bringing a list of questions to your visit is also a smart idea. The following are some frequently asked questions:

What is the purpose of an esophagoscopy? Is there anything else I can do to diagnose or treat my condition?
How long will it take to finish the esophagoscopy? When will I return home?
What limitations will I face following the treatment, and when can I expect to resume work and other activities?
What kind of help will I require at home? Will I require transportation home?
What is the best medication to take before and after the procedure?
How will you deal with my discomfort?
When should I contact you again?
What is the best way for me to get in contact with you? Inquire about phone numbers to contact during and after office hours.
When will the test results be available?

Esophagoscopy Procedure

Depending on the procedure, your complaints or diagnosis, and other considerations, the technique used to do your esophagoscopy will differ. For certain procedures, general steps are presented.

Flexible Esophagoscopy

Flexible esophagoscopy is usually done at a doctor's office, an outpatient procedure center, or a hospital procedure unit. It takes about half an hour or less and involves the following steps:

You put on a hospital gown. You'll be placed on an examination table by your medical team. As needed, your care staff will provide you with blankets for privacy and warmth.
To numb the back of your throat and lessen the gag reflex, your physician or care team sprays a topical anesthetic into it. Your doctor may also prescribe a light sedative to make you sleepy and calm, as well as a painkiller. Intravenous medication is a type of medication that is administered through the veins (through an IV line). Deeper sedation or anesthesia, in which you are completely relaxed and unconscious of the treatment, may be employed in some circumstances. It's possible you won't remember it. During IV sedation, your vital signs are monitored by your medical staff.
During the treatment, your doctor will have you wear a special mouthpiece to secure your teeth.
A small, flexible endoscope is inserted via your mouth or nose, down your neck, and into your esophagus by your specialist. The doctor takes pictures, which are then displayed on a video screen. To help guide the endoscope down the esophagus, you may be instructed to swallow at different points.
The endoscope is removed from the esophagus by your doctor. This is when the most detailed evaluation is performed, as well as procedures such as tissue biopsy and treatments.

Rigid Esophagoscopy

Rigid esophagoscopy is usually done in a hospital setting. This procedure usually takes around an hour and is performed under general anesthesia. You can predict the following on the day of your procedure:

Speak with a nurse who specializes in preoperative care. The nurse will do an examination and confirm that all necessary tests have been completed, as well as that you have read and signed the surgical consent form.
Take off jewelry and clothing and change into a patient gown. If at all feasible, leave all valuables and jewelry at home or with a family member. Your care team will provide you with blankets to keep you warm and quiet.
Discuss your medical history and the type of anesthesia you will receive with the anesthesiologist or nurse anesthetist.
Your medical team will start an IV and administer a mixture of IV medications and inhaled gases. As the rigid endoscope is introduced into your esophagus, you will not feel or remember the event.
Your vital signs and other vital body processes are monitored by your medical staff. This occurs throughout the procedure and recovery until you are conscious, breathing regularly, and your vital signs have stabilized.

Both you and your care team place a high value on your comfort and relaxation. During the process, you may feel pressure in your throat and will be unable to speak. To keep you quiet and comfortable, your care team will administer pain and sedative drugs. Patients frequently doze off throughout the procedure. If you receive general anesthesia, you will not feel or recall the procedure.

What Happens after Esophagoscopy?

Knowing what to expect following an esophagoscopy can assist you in resuming your normal routine as quickly as possible.

After the procedure, you may experience a sore throat, bloating, gas, and cramping. These signs and symptoms should be minor and transient. If they are not improving or are growing worse, call your doctor because this could be a symptom of a problem. The anesthetic or sedative may cause you to feel drowsy for up to 24 hours.

After your esophagoscopy, you will need to stay in the doctor's office, a surgical outpatient unit, or a hospital for a brief time. The time it takes depends on your age, overall health, and the treatment and anesthetic administered.

If you've been sedated, your doctor will let you go home once you're awake, breathing normally, and your vital signs have stabilized. Depending on the type of sedation, this can take an hour or two. After sedation, you won't be able to drive for roughly 24 hours. You'll need transportation home after your appointment. Because you may still be drowsy, someone should remain with you for a day or two.

If you were given general anesthesia, you will be kept in the recovery area until you are awake, breathing normally, and your vital signs have stabilized. You may be able to go home the same day in certain circumstances, but a hospital stay may be necessary for others.

Esophagoscopy Risks

Esophageal complications are uncommon after an esophagoscopy. Any practice, however, comes with risks and the probability of complications, which can be catastrophic in some situations. During the treatment or recovery, complications may arise. The following are some of the risks and consequences associated with an esophagoscopy:

An allergic reaction or respiratory issues, for example, can occur as a result of anesthesia, sedation, or drugs.
Bleeding
Swallowing problems and a painful throat
Perforation or tear of the esophagus
Fever
Infection
Serious injury to your teeth, jaw joint, lips, or throat.
Pain
Subcutaneous surgical emphysema is a type of emphysema in which air is collected beneath the skin.

You can decrease your chance of certain complications by doing the following:

Before your surgery and during recuperation, you must adhere to the following activity, nutritional, and lifestyle restrictions and advice.
Any problems, such as bleeding, fever, or an increase in pain, should be reported to your doctor immediately.
Taking your medications as prescribed.
If you have any known allergies, you must tell all members of your care team.

When to Call your Doctor?

Following an esophagoscopy, it's critical to keep your follow-up visits. If you have any questions or concerns in between checkups, call your doctor. If you have any of the following complaints, call your doctor immediately:

Bloody or black feces, gastrointestinal bleeding (bleeding per rectum), or vomiting blood are all signs of bleeding.
Shortness of breath, trouble breathing, labored breathing, or wheezing are all symptoms of breathing issues.
Chest pain
Cough that persists for longer than usual
Fever
Pain or discomfort that worsens or does not go away as quickly as it should.
Hoarseness or a sore throat that lasts longer than usual.

Conclusion

Esophagoscopy is the primary diagnostic method for any esophageal illness suspected. It can also be utilized for a variety of therapeutic procedures, such as ablative energy delivery (cautery and photodynamic or laser treatment) for tumors, variceal banding, cauterization or injection for bleeding, stent deployment, foreign object removal, and other surgical manipulations. All esophageal and general thoracic surgeons must be skilled in esophagoscopy, and several surgical organizations have set and published requirements for competence gain.