Difficulties Of Esophagoscopy

Sources: A Manual Of Peroral Endoscopy And Laryngeal Surgery

The beginner may find the

esophagoscope seemingly rigidly fixed, so that it can be neither

introduced nor withdrawn. This usually results from a wedging of the

tube in the dental angle, and is overcome by a wider opening of the

jaws, or perhaps by easing up of the bite block, but most often by

correcting the position of the patient's head. If the beginner cannot

start the tube into the pyriform sinus in an adult, it is a good plan

to expose the arytenoid eminence with the laryngoscope and then to

insert the 7 mm. esophagoscope into the right pyriform sinus by direct

vision. Passing the cricopharyngeal and hiatal spasmodically

contracted narrowings will prove the most trying part of

esophagoscopy; but with the head properly held, and the tube properly

placed and directed, patient waiting for relaxation of the spasm with

gentle continuous pressure will usually expose the lumen ahead. In his

first few esophagoscopies the novice had best use general anesthesia

to avoid these difficulties and to accustom himself to the esophageal

image. In the first favorable subject--an emaciated individual with no

teeth--esophagoscopy without anesthesia should be tried.

In cases of kyphosis it is a mistake to try to straighten the spine.

The head should be held correspondingly higher at the beginning, and

should be very slowly and cautiously lowered.

Once inserted, the esophagoscope should not be removed until the

completion of the procedure, unless respiratory arrest demands it.

Occasionally in stenotic conditions the light may become covered by

the upwelling of a flood of fluid, and it will be thought the light

has gone out. As soon as the fluid has been aspirated the light will

be found burning as brightly as before. If a lamp should fail it is

unnecessary to remove the tube, as the light carrier and light can be

withdrawn and quickly adjusted. A complete instrument equipment with

proper selection of instruments for the particular case are necessary

for smooth working.