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Stage 4 Passing Through The Hiatus EsophageusCategory: INTRODUCTION OF THE ESOPHAGOSCOPE Source: A Manual Of Peroral Endoscopy And Laryngeal Surgery When the head is dropped, it must at the same time be moved horizontally to the right in order that the axis of the tube shall correspond to the axis of the lower third of the esophagus, which deviates to the left and turns anteriorly. The head and shoulders at this time will be found to be considerably below the plane of the table top (Fig. 71). The hiatal constriction may assume the form of a slit or rosette. If the rosette or slit cannot be promptly found, as may be the case in various degrees of diffuse dilatation, the tube mouth must be shifted farther to the left and anteriorly. When the tube mouth is centered over the hiatal constriction moderately firm pressure continued for a short time will cause it to yield. Then the tube, maintaining this same direction will, without further trouble glide into and through the abdominal esophagus. The cardia will not be noticed as a constriction, but its appearance will be announced by the rolling in of reddish gastric mucosal folds, and by a gush of fluid from the stomach. [FIG. 70.--Schematic illustration of the author's high-low method of esophagoscopy, fourth stage. Passing the hiatus. The head is dropped from the position of the 1st and 2nd stages, CL, to the position T, and at the same time the head and shoulders are moved to the right (without rotation) which gives the necessary direction for passing the hiatus.] [FIG. 71.--Esophagoscopy by the author's high-low method. Stage 4. Passing the hiatus The patient's vertex is about 5 cm. below the top of the table.] Normal esophageal mucosa under proper illumination is glistening and of a yellowish or bluish pink. The folds are soft and velvety, rendering infiltration quickly noticeable. The cricoid cartilage shows white through the mucosa. The gastric mucosa is a darker pink than that of the esophagus and when actively secreting, its color in some cases tends toward crimson. Secretions in the esophagus are readily aspirated through the drainage canal by a negative pressure pump. Food particles are best removed by sponge pumping, or with forceps. Should the drainage canal become obstructed positive pressure from the pump will clear the canal. Next: Difficulties Of Esophagoscopy Previous: Stage 3 Passing Through The Thoracic Esophagus
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