Contraindications To Esophagoscopy


Categories: DISEASES OF THE ESOPHAGUS
Sources: 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

inefficient.



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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