Esophagoscopy - Types, Contraindications, Procedure, and Risks

Introduction

The examination of the esophagus using an esophagoscope is called an esophagoscopy. An esophagoscope consists of a thin tube with a light and a lens attached to it to view the esophagus. It is a reliable diagnostic and therapeutic tool with many applications.

What Is Esophagoscopy?

The examination of the esophagus using an endoscope is called an esophagoscopy. An esophagoscope consists of a thin tube with a light and a lens attached to it to view the esophagus. The esophagus is a long, muscular tube that helps transport food and liquid from the oral cavity to the stomach. It also contains a tool for removing tissue from the esophagus for a biopsy or other examination.

Is Esophagoscopy the Same as Endoscopy?

Endoscopy is the procedure used to view internal organs and cavities. It might require an incision to insert the endoscope and other tools needed for the procedure.

Esophagoscopy is also a type of endoscopy, but it differs because an esophagoscopy does not require incisions. Instead, in an esophagoscopy, the endoscope is inserted through the mouth into the food pipe (esophagus) to view the upper part of the gastrointestinal tract. The procedure can be done with a physical examination and ultrasound imaging.

What Are the Types of Esophagoscopy?

The different types of esophagoscopy include:

1. Rigid Esophagoscopy - This procedure involves the insertion of a stiff, rigid tube into the esophagus through the mouth. The tube has an eyepiece, lenses, and light that enable visualization of the esophagus and other internal structures in the upper GI (gastrointestinal) tract. This type is used in minor surgeries and widely for diagnostic purposes.

2. Flexible esophagoscopy - In this type, a thin, flexible tube is inserted through the mouth into the esophagus. Thin electrical cables are in the tube, providing light to see the structures. These cables are connected to the monitor to see the captured images.

3. Transnasal esophagoscopy - This is the least intrusive type and does not require any anesthesia. The endoscope is inserted through the nostril, into the nasal cavity, down back, and into the esophagus, which is mainly used for diagnostic purposes.

Why Is an Endoscopy Done?

An esophagoscope can be used as part of the physical examination if the patient presents with complaints of nausea, vomiting, difficulty swallowing, feeling a lump in the throat while swallowing, persistent heartburn despite medication and lifestyle modifications, laryngopharyngeal reflux (stomach acid moving through the esophagus into the throat), etc. It diagnoses conditions affecting the throat, esophagus, stomach, and intestine. Doing esophagoscopy alone is usually rare; it is generally done along with a more extensive endoscopy to visualize the esophagus, the stomach, and the upper parts of the intestine. It is used to:

• Investigate the causes of the abnormal throat, stomach, or intestinal symptoms.

• Take a biopsy to diagnose conditions like a malignant tumor or other conditions like dysphagia or GERD (Gastroesophageal reflux disease).

• Remove a large bolus (a large mass of food) or any foreign substance from the esophagus.

• Visualize the GI tract during surgery.

• Barrett’s esophagus is a condition where the normal esophageal tissue gets replaced with intestinal tissue.

• Presence of swollen veins in the esophagus.

• An abnormal tissue growth.

When Is an Endoscopy Contraindicated?

Esophagoscopy is a relatively safe procedure, with a complication risk of 1 in 1000 procedures. It is absolutely contraindicated in the following cases:

• Hemodynamic instability is a condition in which there is an abnormal instability in blood pressure, which can cause an insufficient blood supply to the organs.

• Failure to obtain consent for the procedure.

• High chances of perforation.

Relative contraindications include:

• Anticoagulation in the appropriate setting (like esophageal dilation).

• Surgery of the head and neck.

• The pharyngeal diverticulum, also called Zenker's diverticulum, is a pharyngeal pouch that forms when the throat's lower part meets the esophagus's upper part.

• Patients with a history of procedural intolerance.

How Is an Endoscopy Done?

The procedure can last from half an hour to three hours, depending on the type of procedure done. It is usually an outpatient procedure, enabling the patient to be discharged on the same day. The steps include:

1. Anesthesia is given to reduce discomfort during the procedure. Depending on the procedure, it can be an IV (intravenous) or a topical anesthetic.

2. The endoscope is inserted gently through the nose or mouth, slowly into the throat.

3. The doctor observes through the eyepiece or the monitor displaying the captured images. Sometimes, a small amount of air is injected into the esophagus to open it for better visualization.

4. Tools such as forceps or a hollow suction tube are used to remove the abnormal tissues or mass or to suck out any blockages in the esophagus.

5. Performs any necessary procedures to treat esophageal conditions.

6. After the procedure is completed, the endoscope is removed gently. The patient is observed for any post-procedure complications and allowed to recover from the anesthesia.

What Are the Risks Associated With an Esophagoscopy?

An esophagoscopy is considered relatively safe, with minimal risks. Most complications observed are temporary and heal quickly. Possible risks are:

• Soreness in the throat, pain, or discomfort in the throat.

• Hoarseness in voice.

• Mild difficulty swallowing for a few days.

• Irritation, injury, and perforation (tearing) of the tissues in the esophagus.

• Air trapped under the skin (subcutaneous surgical emphysema).

• Internal bleeding or hemorrhage.

• Infection.

• Fever.

• Allergic reactions to the anesthesia used.

• Adverse reactions to medications.

• Aspiration.

• Oversedation.

• Airway obstruction.

How Is the Recovery After the Procedure?

The patient would probably be tired after the procedure, especially if anesthesia were given. However, the effects of the anesthesia would fade within a day. The patient would be discharged after a few hours of observation post-procedure. A bystander is advised to accompany the patient, as the patient can be too weak to drive home alone. The discomfort of the procedure would fade gradually. Seek medical intervention in case of:

• Pain and discomfort worsen over time.

• Blood is present in vomit or stools.

• Difficulty breathing.

• Chest pain.

• Fever.

Conclusion:

Esophagoscopy is a reliable diagnostic and therapeutic tool with many applications. It is one of the safest and most effective diagnostic tools for upper GI tract conditions. There are several types of esophagoscopy available. Examination with esophagoscopy is rare and is done part of endoscopy examination.