Stage 4 Passing Through The Hiatus Esophageus

Sources: 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


[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