Esophagoscopy

Updated: Sep 20, 2017
  • Author: Dan C Cohen, MD; Chief Editor: Kurt E Roberts, MD  more...
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Overview

Background

Esophagoscopy is a procedure in which a flexible endoscope is inserted through the mouth or, more rarely, through the nares and into the esophagus. The endoscope uses a charge-coupled device to display magnified images on a video screen. The procedure allows visualization of the esophageal mucosa from the upper esophageal sphincter all the way to the esophagogastric junction (EGJ).

This procedure is one of several procedures that fall under the category of upper endoscopy, including gastroscopy, esophagogastroduodenoscopy (EGD), and enteroscopy. Esophagoscopy alone is uncommon: It is generally performed as part of a more complete upper endoscopic procedure in which the esophagus, stomach, and portions of the small intestine are explored endoscopically.

In the United States, esophagoscopy is usually performed with moderate sedation, which is achieved by administering a narcotic and benzodiazepine in combination. In Europe and Asia, however, the procedure is commonly performed without sedation. Topical anesthesia is sometimes implemented to improve patient tolerance and comfort. Very rarely, general anesthesia is used in patients who are difficult to sedate or are at higher risk of airway compromise. There is some evidence for the effectiveness of unsedated esophagoscopy in monitoring pediatric esophageal disease. [1, 2]

The focus of this article is on transoral esophagoscopy. For information regarding transnasal esophagoscopy, see Transnasal Esophagoscopy.

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Indications

Esophagoscopy is routinely performed in an outpatient setting, though inpatient and emergency department management of gastrointestinal diseases often require urgent inpatient upper endoscopy including but not limited to esophagoscopy. Moreover, certain conditions necessitate routine esophageal endoscopic surveillance and therapeutics. In such cases, a procedure may be limited to esophageal exploration alone. The indications for esophagoscopy are as follows:

  • Food bolus or foreign object impaction
  • Evaluation and management of  gastroesophageal reflux disease (GERD), [3]  including noncardiac chest pain.
  • Screening and surveillance of  Barrett esophagus [4, 5]  (see the video below)
  • Treatment and surveillance of  esophageal varices [6]
  • Evaluation and management of  dysphagia, [7]  including dilation of esophageal strictures
  • Evaluation and management of odynophagia
  • Evaluation and management of esophageal cancer, [8, 9]  including placement of esophageal stents
  • Evaluation of the esophagus after abnormal imaging studies
This video, captured via esophagoscopy, shows a long circumferential segment of Barrett esophagus. Video courtesy of Dawn Sears, MD, and Dan C Cohen, MD, Division of Gastroenterology, Scott & White Healthcare.
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Contraindications

Esophagoscopy is considered a safe procedure, with a complication risk of approximately 1 per 1000 procedures. [10, 11]  Absolute contraindications include the following:

  • Hemodynamic instability
  • Failure to obtain consent
  • Possibility of perforation

Relative contraindications for esophagoscopy include the following:

  • Anticoagulation in the appropriate setting (ie, esophageal dilation)
  • Head and neck surgery
  • Pharyngeal diverticulum
  • History of procedure intolerance
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Technical Considerations

Best practices

The American Society for Gastrointestinal Endoscopy (ASGE) recommends understanding of indications, limitations, contraindications, alternatives, principles of conscious sedation, and correct interpretation of endoscopic findings to achieve competency in performing upper endoscopic procedures.

Furthermore, ASGE has determined that a minimum of 100 upper endoscopic procedures are required for trainees to attain competency in diagnostic upper endoscopy.

Therapeutic upper endoscopy poses further challenges and complexities and therefore requires additional training. ASGE recommendations for the requirements to attain competency in therapeutic upper endoscopy are available through the society Web site (see American Society for Gastrointestinal Endoscopy).

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