Retrograde Esophagoscopy


Categories: ACQUIRING SKILL
Sources: A Manual Of Peroral Endoscopy And Laryngeal Surgery

The first step is to get rid of the

gastric secretions. There is always fluid in the stomach, and this

keeps pouring out of the tube in a steady stream. Fold after fold is

emptied of fluid. Once the stomach is empty, the search begins for the

cardial opening. The best landmark is a mark with a dermal pencil on

the skin at a point corresponding to the level of the hiatus

esophageus. When it is desired to do a retrograde esophagoscopy and

the gastrostomy is done for this special purpose, it is wise to have

it very high. Once the cardia is located and the esophagus entered,

the remainder of the work is very easy. Bouginage can be carried out

from below the same as from above and may be of advantage in some

cases. Strictural lumina are much more apt to be concentric as

approached from below because there has been no distortion by pressure

dilatation due to stagnation of the food operating through a long

period of time. At retrograde esophagoscopy there seems to be no

abdominal esophagus and no cardia. The esophagoscope encounters only

the diaphragmatic pinchcock which seems to be at the top of the

stomach like the puckering string at the top of a bag.



Retrograde esophagoscopy is sometimes useful for stringing the

esophagus in cases in which the patient is unable to swallow a string

because he is too young or because of an epithelial scaling over of

the upper entrance of the stricture. In such cases the smallest size

of the author's filiform bougies (Fig. 40) is inserted through the

retrograde esophagoscope (Fig. 43) and insinuated upward through the

stricture. When the tip reaches the pharynx coughing, choking and

gagging are noticed. The filiform end is brought out the mouth

sufficiently far to attach a silk braided cord which is then pulled

down and out of the gastrostomic opening. The braided silk string

must be long enough so that the oral and the abdominal ends can be

tied together to make it endless; but before doing so the oral end

should be drawn through nose where it will be less annoying than in

the mouth. The purpose of the string is to pull up the retrograde

bougies (Fig. 35)





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