What Is an Esophagoscopy?

Fiber laryngoscope, bronchoscope, and esophagoscopy are collectively referred to as fibroptic endoscopy. Among them, fiber nasopharyngoscope, bronchoscope, and esophagoscopy are commonly used in ENT.

Fiber Esophagoscopy

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Fiber laryngoscope, bronchoscope, and esophagoscopy are collectively referred to as fibroptic endoscopy. Among them, fiber nasopharyngoscope, bronchoscope, and esophagoscopy are commonly used in ENT.

Chinese name

Fiber Esophagoscopy

Branch

Thoracic Surgery

Fiber Esophagoscopy

Fiber-optic esophagoscopy; fiber-optic esophagoscopy; esophageal fiberoscopy; fiber-esophagoscopy; fiber-esophagoscopy; fiber-esophagoscopy

ICD code: 42.2301

For thoracic surgeons, the use of fibroesophageoscopy is far less frequent than that of bronchoscopy. This is not because there are fewer esophageal cancer patients than lung cancer patients, but that the diagnosis of esophageal cancer is easier to determine. Symptoms of dysphagia and signs of barium meal radiography of the esophagus allow 95% of patients to be diagnosed, and few need to be confirmed by esophagoscopy. However, fibroesophageoscopy is still a technique that thoracic surgeons must master.

Fiber esophagoscopy is suitable for:

1. Patients with difficulty swallowing or esophageal obstruction.

2. X-ray barium meal examination of patients with suspected esophageal cancer.

3. X-ray barium meal examination found that patients with esophageal local pressure.

4. For patients with esophageal cancer after radiotherapy or surgical resection, when recurrence is suspected, it can be confirmed by microscopy.

1. Severe hypertension, heart disease, and cardiopulmonary insufficiency.

2. Aortic aneurysms compress the esophagus.

3. The lesion at the entrance of the esophagus has caused obstruction, and the lens cannot pass through. Observation is difficult. Consider using a rigid esophagoscopy.

4. Sharp foreign bodies or malignant lesions cause caution in patients with esophageal perforation. Fibre microscopy should be inflated with water, which is likely to aggravate mediastinal infection.

1. Anesthesia is mainly local anesthesia. Use 1% tetracaine 2 ~ 3ml and spray it on the mucous membrane of the pharynx to make the patient hold the medicine solution and do not spit it out. Spray at intervals of about 3 minutes, and anesthesia can be achieved 3 to 5 times. Finally swallow the medicine.

2. Posture patient was placed in the left side after anesthesia, with both legs flexed naturally and the whole body relaxed.

1. The surgeon first checks whether the functions of the light source, suction, air blowing, water injection and adjustment knobs of the fiberscope are normal. Then stand on the patient's head and face the patient, so that the patient gently bites the dental pad with a channel, the operator holds the lens manipulation part with his left hand; bends the lens into an arc with his right hand, and sends it to the mouth cavity through the dental pad hole.

2. Turn the lower knob to straighten the lens, push it down along the posterior wall of the pharynx, and observe as you go in, to the opening of the esophagus of the hypopharynx, apply a little pressure to the lens until the esophageal opening is opened or the patient will swallow The lens can smoothly enter the esophagus cavity.

3. After entering the esophagus, intermittently inject an appropriate amount of gas to expand the esophagus to ensure that the lens advances and observes the lesion under direct vision.

4. First deliver the camera to the cardia department, and then carefully observe each section of the esophagus while looking back. After finding the lesion, measure its length and distance from the incisors, and then take a biopsy as the case may be. Observe no active bleeding, that is, exit the fiberscope while attracting.

1. If there are no adverse reactions, the patient can leave. For biopsy, take soft food for 1 to 2 days.

2. Fully clean the surface of the lens body, flush the cavity, and absorb the moisture in it. The distal mirror is coated with wax, and the lens body is kept in oil for storage.

ICD code: 42.2402

classification

Otorhinolaryngology / Endoscopy / Fibrolarynx, Bronchus, Esophagoscopy

Overview

Fiber laryngoscope, bronchoscope, and esophagoscopy are collectively referred to as fibroptic endoscopy. Among them, fiber nasopharyngoscope, bronchoscope, and esophagoscopy are commonly used in ENT.

A complete set of fiber endoscope equipment includes the following three parts: fiber endoscope (such as fiber laryngoscope, fiber bronchoscope); cold light source; accessories (camera, teaching mirror, camera-monitoring system, biopsy forceps, foreign body Pliers, hair brushes, cleaning brushes, suction tubes, etc., Figure 9.7.6.3-0-4).

The structure of fiberoptic esophagoscopy is basically similar to that of fiberoptic bronchoscope, with a length of 960mm and a diameter of 9mm. It is equipped with suction, aspiration, cleaning devices and forceps, and can be inserted with biopsy forceps or injection.

Indication

Fiber esophagoscopy is suitable for:

1. Intractable retrosternal pain or esophageal obstruction.

2. Unexplained dysphagia and esophageal obstruction.

3. Take the diseased tissue or observe the effect on the esophageal mass.

4. Unexplained vomiting, vomiting blood, acid reflux and loss of appetite, and those who have positive findings after barium meal and gastroscopy.

Contraindications

1. Acute upper respiratory tract infection.

2. People with severe hypertension, cardiopulmonary insufficiency, and excessive physical weakness.

3. Aortic aneurysm patients.

4. Esophageal corrosive burns and varicose veins with large vomiting less than 2 weeks.

5. Obstructive lesions at the entrance of the esophagus or foreign bodies in the esophagus, it is not appropriate to use optical fiber esophagoscopy.

Preoperative preparation

Fast food and water 6 hours before surgery, 30 mg of atropine is injected subcutaneously 30 minutes before surgery. For individuals with emotional stress, sedatives such as diazepam or phenobarbital can be given appropriately. Removable dentures should be removed, and nasal secretions should be removed with suction .

Anesthesia and posture

Conventional anesthesia on the mucosa is used to spray the oral cavity and pharynx 3 to 4 times with 0.5% to 1% tetracaine or 2% lidocaine, for a total of about 2 to 3 ml. Ask the patient to swallow the anesthetic.

Surgical procedure

1. The patient is lying on the left side, with a headrest and high pillows, legs flexed, body muscles relaxed, and mouth cushions.

2. The operator sits on the left side of the patient and holds the operation part of the mirror with his left hand. The right hand assists the rotation of the angle button to adapt the distal end to the curvature of the patient's mouth and pharynx. The assistant held the dental pad with his left hand, and put the distal end of the lens into the entrance with his right hand, entering about 15cm, reaching the pear-shaped fossa. At this time, he felt greater resistance, unclear vision, and was blind. When the upper mouth of the esophagus is opened, the resistance disappears and the lens body slides into the esophagus.

3. Observe the esophageal mirror tube after entering the esophagus, immediately send in air, adjust the angle button to see the four walls of the esophagus as the degree, and the esophageal cavity must be seen. Water was passed through the esophagus and inserted slowly. You can see the state and movement of the esophagus, the aortic arch pressure, the left bronchial pressure, and the heart beat. When the lens body enters about 40cm, you can see the petal-shaped mucosal folds of the chrysanthemum. When the cardia is open, you can enter the stomach, then slowly withdraw, and observe while exiting. During the inspection, attention should be paid to the activity and hardness of the tube wall, the lumen condition and the shape of the mucosal folds, and the depth of entry of the mirror tube should be paid attention at any time. If a lesion is found, its position and depth from the central incisor should be recorded, a photographic record and tissue taken. Observation of the entrance of the esophagus can usually only be performed when the mirror tube is withdrawn. Therefore, optical fiber esophagoscopy sometimes cannot achieve the purpose of observing obstructive lesions at the entrance of the esophagus, and sometimes it is necessary to use rigid tube esophagoscopy.

Points to note during surgery

1. During esophagoscopy, the barium meal radiography data must be consulted, and the patient's general condition must be understood.

2. When passing through the entrance of the esophagus, do not use excessive force to avoid causing damage to the mucosa.

3. Tissues can only be taken after esophageal varices have been ruled out.

4. For viscous secretions and food residues retained in the esophagus, it is best to irrigate and aspirate first, so as not to contaminate the mirror surface or block the passage of the mirror body, affecting the observation effect.

5. When shooting, the distance between the distal end of the lens body and the lesion should be 1 ~ 1.5cm, otherwise the image will be blurred.

Postoperative management

1. Ask the patient to spit out the secretions in the mouth. If there is no discomfort, you can get out of bed and move into liquid or soft food after 2 hours.

2. Wash the lens body with water and 1: 1000 benzalkonium bromide, flush the instrument channel, blow dry thoroughly, and then store it with oil.

complication

1. Laryngeal and bronchospasm, bronchial wheezing.

2. Mucosal damage and even perforation of the esophagus.

3. Heart rhythm disorders or heart area discomfort, in this case, should stop operation (for patients with a history of heart disease and elderly and frail, it is best to have ECG monitoring).

4. Patients with history of hemoptysis or hemoptysis, history of blood diseases, low immune function, easy to bleed during surgery. When a biopsy is to be performed, 1: 10,000 adrenaline drops should be injected into the esophagus to stop bleeding.