Esophagoscopy:What,Why,How & When

What is Esophagoscopy?

Esophagoscopy is a procedure in which your surgeon looks inside your food pipe. You may wonder about the purpose of esophagoscopy.

Why is an Esophagoscopy done?

When a foreign object like a coin, chicken bone, mutton bone, denture gets stuck in the throat, it’s serious. If it’s stuck anywhere in the food pipe, not going up or down then it has to be removed. Esophagoscopy is done to remove the foreign object.

Anything stuck in the food pipe will make eating and swallowing painful difficult and eventually can cause serious life-threatening infection. Esophagoscopy is done to remove the foreign object lodged in the esophagus or food pipe.

It is also done to take a biopsy or perform some procedure.

What is an Esophagoscope?

Esophagoscope is an endoscope.

There are two types of Flexible and rigid esophagoscope. The availability and ability for it in India depend on the tier of healthcare service.

A rigid esophagoscope is a tube-like structure which has a light attached to it and is introduced into the food pipe under general anesthesia. A flexible esophagoscope is, narrower and flexible and can be performed under local or General Anaesthesia.

Simple right?

Not really.

The procedures require a lot of skill and expertise of both the surgeon and anesthesia and has some serious contraindications and complications. The good news is if the patient presents early and has no serious medical condition and is an adult the course is easier. It gets complicated with toddlers, young children and elderly with multiple chronic lifestyle diseases.

What is the most important thing you should know about Esophagoscopy?

Never delay checking with your doctor, if you suspect impaction of any foreign body in the throat or anything sticking in your throat for a long time than normal.

What are the conditions when an X-ray doesn’t show a foreign object and the patient has a complaint?

In case of a non-metallic foreign substance like plastic whistles etc, the Xray doesn’t pick up the object. Sometimes when people eat meat, post a heavy bout of drinking, the meat bolus may get stuck in the throat. This again will need a different set of investigation.

What are the causes of worry?

• An old foreign body, disc battery, old mutton bone, chicken bone, elderly patient and kids are all cause for worry.
• Any chronic foreign body sensation in the back of the throat needs to be evaluated, to rule out supraglottic malignancy and or pharyngeal malignancy.
• Extreme age groups and associated chronic illness.
• Bleeding varix or bleeding ulcers

Before Esophagoscopy you will need to give an informed consent for the procedure

Your doctor will explain the procedure and you will be required to give a consent after knowing the risks associated with the procedure. This is important in order for you to understand the nature of the procedure and the risks involved. This is in your best interest. In case of any systemic chronic illness, heart conditions, cervical spinal problems, bronchial asthma, you need to tell your doctor about it.

Rigid esophagoscopy is done under general anesthesia and needs a postoperative hospital stay. We do a postoperative check x-ray of the neck and chest, to rule out any complications.

Flexible Oesophagoscopy

A flexible esophagoscopy may be attempted under local anesthesia depending on patient comfort and procedure needed.

What kind of a doctor performs an esophagoscopy?

These procedures are done by ENT surgeons and Gastroenterology  Medicine specialist will do diagnostic flexible oesophagoscopy.
Only qualified experienced doctors to perform. These procedures as it needs a high level of skill expertise and detailed knowledge about anatomy.

Indications for rigid esophagoscopy
Diagnostic to find out the cause of difficulty swallowing

• cancer esophagus
• cardiac achalasia
• strictures,
• esophagitis
• diverticula, etc.

Therapeutic

• Removal of a foreign body.
• Dilatation in case of esophageal strictures or cardiac achalasia.
•  Endoscopic removal of benign tumors.
• Insertion of a tube for palliative treatment of esophageal carcinoma.
• Injection of esophageal varices.

Contraindications of Oesophagoscopy

• Trismus
• Cervical spine diseases
• Receding or fractured mandible
• Aneurysm of the aorta
•  Heart, liver or kidney disease will need to be assessed on a case to case basis.
• Local injury to lips and teeth.
• Injury to arytenoids.
• Injury to the oropharyngeal mucosa.
• Perforation of the esophagus.
• Tracheal compression
• Esophagoscope may press on the posterior tracheal wall, especially in children, causing obstruction to respiration and cyanosis.

Flexible Esophagoscopy/Transnasal esophagoscopy

Primary advantage over the rigid Esophagoscopy

• It is an office procedure.
• General Anaesthesia may be avoided.
• Is possible in people with problems of spine, jaw and other technically challenging cases.
• It can examine the esophagus , stomach, and duodenum and give a comprehensive diagnosis.

Indications of Flexible Esophagoscopy

• Taking biopsies,
• Removal of small foreign objects
• Excision of small tumors
• Dilatation of webs or strictures.
• Injecting bleeding varices with sclerosants.
• In malignancy or stricture due to other causes, a esophageal stent can be placed as a palliative measure.

Postoperatively

• If under GA nil per mouth as advised by anaesthesist.
• Monitoring  pulse, temperature, respiratory rate
• Any complaint of respiratory difficulty
• Chest pain or pain in the interscapular region.

What is a pharyngoscopy?

Pharyngoscopy is an endoscopic examination of the pharynx. The part of your food pipe at the back part of your throat, behind the uvula.

What is a hypopharyngoscopy?

Hypoharyngoscopy is for examination of the lower part of the pharynx and the junction of the pharynx and oesophagus.

Is a esophagoscopy painful?

The rigid esophagoscopy is done under General anesthesia and you will not feel any discomfort.

The flexible esophagoscopy is well tolerated under local anesthesia and can have some discomfort but is not painful.

Where to go if you need to get a Esophagoscopy done in India?

• Visit your nearest Government Medical College
• Visit a Private Hospital with an ENT setup, ICU facility, and the necessary infrastructure, for performing the procedure.

Disclaimer: This is meant for Healthcare awareness and not a replacement for an in-person Doctor’s consultation. Kindly take all health decisions after a complete Doctor’sconsultation Read my full disclaimer. Healthcare information is constantly evolving and while Healthwealthbridge tries to keep information updated, Healthwealthbridge will not be deemed responsible for any omission or commission in this regards under any circumstances.

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Reference:

The Role of Transnasal Esophagoscopy in ENT Office: A Prospective, Multicenter Study in Korea

The role of rigid oesophagoscopy in oesophageal carcinoma.

Foreign body Esophagus

10 Things you should not allow children to play with

Management of Foreign Bodies of Upper Digestive Tract

Scott-Brown’s Otorhinolaryngology and Head and Neck Surgery

Diseases of Ear ,Nose and Throat by P.L Dhingra