Esophagoscopy - Causes, symptoms and treatment. MF.

Esophagoscopy is an instrumental method for diagnosing diseases of the esophagus with the aid of an endoscope( probe) inserted through the oral cavity.

This method of examination allows you to visually inspect the internal wall of the esophagus, detect pathological changes in the organ, and carry out the necessary diagnostic or therapeutic manipulations, for example, taking material for histological examination, removing the foreign body, stopping bleeding, etc.

Due to the fact thatThis method is informative and relatively safe, in recent years, esophagoscopy is widespread, and it can be performed in a polyclinic.
Esophagoscopy is performed in a planned or emergency manner, and can also be performed under local anesthesia or general anesthesia. As a rule, the examination is carried out together with examination of the stomach and duodenum with fibroesophagogastroduodenoscopy( FEGDS), but can also be prescribed as an independent diagnostic method.

Indications for esophagoscopy

Indications for diagnostic esophagoscopy:

- abnormalities of the esophagus,
- cardiac achalasia( narrowing of the lower esophageal sphincter at the site of the esophagus into the stomach and pathological expansion of the esophagus above it),
- inflammatory and ulcerative esophagitis - esophagitis,
- diverticula and tumors of the esophagus,
- gastroesophageal reflux - back supply of food from the stomach to the esophagus,
- foreign body,
- damage assessmentat a chemical burn of the esophagus on the 7-10th day after poisoning with caustic substance,
- cicatricial strictures( adhesions) of the esophagus, for example, due to chemical burn, to select the optimal size of the bougie - a device used to expand the lumen of the esophagus,
- biopsy - plucking a smalltissue site for further study under a microscope( cytological and histological examination, for example, to clarify the malignancy of the process).

Indications for the treatment of esophagoscopy:

- removal of the foreign body of the esophagus,
- use of sclerosing agents in varicose veins of the esophagus to reduce the risk of bleeding from the veins,
- stop bleeding with electrocoagulation or clipping of the clip onto the bleeding vessel,
-under the control of sight while conducting bougie.

Indications for esophagoscopy with general anesthesia:

- large foreign body of esophagus,
- suspected foreign body wedging into the esophagus wall,
- hearing and speech disorders in the patient,
- mental illness,
- early childhood,
-cardiovascular diseases.

Contraindications.

Esophagoscopy is contraindicated in such diseases:

is the general severe condition of the patient,
is a chemical burn of the esophagus in the acute period( 7-10 days),
is an acute infectious disease,
is an acute internal disease, appendicitis, pancreatitis, intestinal obstruction,
- severe cardiovascular diseases - aortic aneurysm, acute myocardial infarction, pulmonary edema, cardiac decompensation, terminal stage of chronic heart failure,
- neurological diseaseacute stroke, craniocerebral trauma, and so on.

In addition, the study may be difficult in individuals with severe curvature of the spine in the cervicothoracic and with significant obesity.

Preparation for the study.

Esophagoscopy is performed strictly on an empty stomach. The last meal should be no later than 5-6 hours before the procedure. Due to the fact that in most cases the study is not limited to examining the esophagus alone, but includes a further examination of the stomach, it is necessary to exclude the irritating food products( fatty, salty, spicy) within two to three days, to give up alcohol and cigarettes, and alsotemporarily stop taking medication as agreed with your doctor.

Carrying out the research.

Esophagoscopy can be performed in a polyclinic or in a hospital, in a planned or emergency order.20-30 minutes prior to the procedure in the department from which the patient is sent for examination, or directly in the endoscopic study, the patient is injected subcutaneously with atropine and promedol to achieve a better relaxation of the esophagus muscles, and also to obtain a sedative effect.

After the patient is clarified the essence of the study and the patient's signature in informed consent to the procedure, the physician can proceed with esophagoscopy. In the case where the procedure is performed under local anesthesia, the patient may occupy a sitting position, lying on his back with hanging shoulders and a head or lying on his left side. In general, the examination is carried out, as in the case of FEGDS, lying on the left side.

With the help of a solution of dicaine, irrigation of the root of the tongue and oropharynx is performed to lose sensitivity and suppress the emetic reflex. Further, under the supervision of the doctor's vision, the esophagoscope is inserted into the patient along the middle line of the oral cavity, and after reaching the tongue, the doctor turns the esophagoscope down, passing it through the larynx and reaching the entrance to the esophagus. At this point, the patient is invited to do a swallowing movement, after which the endoscope is effortlessly in the esophagus. Then the mucous membrane of the esophagus is inspected, and if the technical equipment of this institution allows, it is possible to display the endoscopic picture on a monitor installed in the office with the subsequent preservation of photo and video materials on a digital medium.

After the examination, the endoscope is removed, the patient is asked to wait for the doctor's opinion, and then he can go home if the examination was done routinely, and there was no dangerous condition requiring emergency care, or the patient is hospitalized in the hospital if esophagoscopy was performedemergency indications, and treatment in stationary conditions is necessary.

The whole procedure takes no more than 20 minutes, causing unpleasant sensations in the patient only during the introduction of the esophagoscope. Possible vomiting, feelings of suffocation and the desire to cough. To ensure that the study does not bring significant discomfort, the patient should relax, sit or lie, without moving and execute the doctor's commands. Over the next few hours, there may be a coughing and sagging behind the sternum. If these signs do not disappear for a day or more, you should tell them about your doctor.

The procedure under general anesthesia is different in that the patient is endotracheally administered inhalation anesthetics, and he falls asleep for the time required for the procedure. Unpleasant sensations can arise at the moment of awakening.

Decoding results.

In the study protocol, the patient will see the main characteristics of the mucosa of the esophagus. Normally, its mucosa is pink in color and has a glossy folded surface. The folds become larger when you go to the stomach. Also, the peristalsis of the esophagus is observed, that is, successive contractions of the muscles towards the stomach. In the case of pathological changes, their nature( foreign body, bleeding, ulcer, diverticulum, etc.), localization and quantity are described.

Photo of normal esophagus with esophagoscopy

Complications of esophagoscopy.

In esophagoscopy, complications such as perforation( getting a through hole) of the esophageal wall, bleeding, anaphylactic shock and allergic reactions, acute violations of breathing and cardiac activity are extremely rare.

Prevention of complications is the complete collection of information on previous allergic diseases, as well as soft, without considerable effort, the introduction of an esophagoscope into the lumen of the esophagus to exclude its traumatization.

Doctor therapist Sazykina O.Yu.