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Contraindications To Esophagoscopy
Category: DISEASES OF THE ESOPHAGUS
Source: A Manual Of Peroral Endoscopy And Laryngeal Surgery
In the presence of aneurysm,
advanced organic disease, extensive esophageal varicosities, acute
necrotic or corrosive esophagitis, esophagoscopy should not be done
except for urgent reasons, such as the lodgment of a foreign body; and
in this case the esophagoscopy may be postponed, if necessary, unless
the patient is unable to swallow fluids. Esophagoscopy should be
deferred, in cases of acute esophagitis from swallowing of caustics,
until sloughing has ceased and healing has strengthened the weak
places. The extremes of age are not contraindications to
esophagoscopy. A number of newborn infants have been esophagoscoped by
the author; and he has removed foreign bodies from patients over 80
years of age.
Water starvation makes the patient a very bad surgical subject, and
is a distinct contraindication to esophagoscopy. Water must be
supplied by means of proctoclysis and hypodermoclysis before any
endoscopic or surgical procedure is attempted. If the esophageal
stenosis is not readily and quickly remediable, gastrostomy should be
done immediately. Rectal feeding will supply water for a limited
time, but for nutrient purposes rectal alimentation is dangerously
Preliminary examination of the pharynx and larynx with tongue
depressor should always precede esophagoscopy, for any purpose,
because the symptoms may be due to laryngeal or pharyngeal disease
that might be overlooked in passing the esophagoscope. A high degree
of esophageal stenosis results in retention in the suprajacent
esophagus of the fluids which normally are continually flowing
downward. The pyriform sinuses in these cases are seen with the
laryngeal mirror to be filled with frothy secretion (Jackson's sign of
esophageal stenosis) and this secretion may sometimes be seen
trickling into the larynx. This overflow into the larynx and lower air
passages is often the cause of pulmonary symptoms, which are thus
strictly secondary to the esophageal disease.
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