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.
Indications
Esophagoscopy is routinely performed in an outpatient setting, though inpatient and emergency department management of gastrointestinal (GI) 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. Indications for esophagoscopy include the following:
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Food bolus or foreign object impaction
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Evaluation and management of gastroesophageal reflux disease (GERD), [3] including noncardiac chest pain.
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Treatment and surveillance of esophageal varices [7]
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Evaluation and management of odynophagia
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Evaluation and management of esophageal cancer, [9, 10, 11] including placement of esophageal stents
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Evaluation of the esophagus after abnormal imaging studies
Contraindications
Esophagoscopy is considered a safe procedure, with a complication risk of approximately 1 per 1000 procedures. [12, 13] Absolute contraindications include the following:
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Hemodynamic instability
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Failure to obtain consent
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Possibility of perforation
Relative contraindications for esophagoscopy include the following:
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Anticoagulation in the appropriate setting (ie, esophageal dilation)
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Head and neck surgery
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Pharyngeal diverticulum
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History of procedure intolerance
Technical Considerations
Best practices
The American Society for Gastrointestinal Endoscopy (ASGE) has recommended understanding of indications, limitations, contraindications, alternatives, principles of conscious sedation, and correct interpretation of endoscopic findings in order to achieve competency in performing upper endoscopic procedures.
Furthermore, ASGE has determined that at least 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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Esophagoscopy on a 3-year-old child. The esophagoscope is introduced via the mouth. As the scope enters the esophageal inlet, you can see the larynx with an endotracheal tube passing through the vocal folds. The esophagocscope meets some resistance as it passes through the upper esophageal sphincter. The esophagus is then entered, and the mucosal lining of the esophagus is evaluated. The esophagus is then passed through the lower esophageal sphincter, entering the stomach. The rugae of the stomach are very distinct. The pylorus is visualized first, and then the scope is turned 180º, and the lower esophageal sphincter is visualized. You can see the scope coming through the lower esophageal sphincter. Video courtesy of Ravindhra G Elluru, MD, PhD.
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This video, captured via esophagoscopy, shows balloon dilation of the distal esophagus. This is performed in patients with dysphagia who are found to have an esophageal stricture or ring. Video courtesy of Dawn Sears, MD, and Dan C Cohen, MD, Division of Gastroenterology, Scott & White Healthcare.
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This video, captured via esophagoscopy, shows band ligation of esophageal varices. Video courtesy of Dawn Sears, MD, and Dan C Cohen, MD, Division of Gastroenterology, Scott & White Healthcare.
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This video shows a normal esophagogastric junction (EGJ). This is where the esophageal squamous mucosa meets the gastric columnar mucosa. Video courtesy of Dawn Sears, MD, and Dan C Cohen, MD, Division of Gastroenterology, Scott & White Healthcare.
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This video, captured via esophagoscopy, shows biopsies being obtained from the esophagus. Video courtesy of Dawn Sears, MD, and Dan C Cohen, MD, Division of Gastroenterology, Scott & White Healthcare.
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Esophagoscopy: This video shows inflammation of the esophagus that appears infectious in origin. Video courtesy of Dawn Sears, MD, and Dan C Cohen, MD, Division of Gastroenterology, Scott & White Healthcare.
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This video, captured via esophagoscopy, shows "trachealization" of this esophagus. This is a condition in which rings in the esophagus resemble the rings of the trachea. This is commonly seen in patients with eosinophilic esophagitis. Video courtesy of Dawn Sears, MD, and Dan C Cohen, MD, Division of Gastroenterology, Scott & White Healthcare.
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This video, captured via esophagoscopy, shows the use of a HALO 360 device to perform radiofrequency ablation for Barrett esophagus. Video courtesy of Dawn Sears, MD, and Dan C Cohen, MD, Division of Gastroenterology, Scott & White Healthcare.
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This video shows esophagoscopy with normal findings. Video courtesy of Dawn Sears, MD, and Dan C Cohen, MD, Division of Gastroenterology, Scott & White Healthcare.
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This video shows esophagoscopy with normal findings. Video courtesy of Dawn Sears, MD, and Dan C Cohen, MD, Division of Gastroenterology, Scott & White Healthcare.
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This video shows esophagoscopy with normal findings. Video courtesy of Dawn Sears, MD, and Dan C Cohen, MD, Division of Gastroenterology, Scott & White Healthcare.
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This video shows a stent that has successfully been deployed into the esophageal lumen. This patient had a small esophageal perforation, and the stent was placed to allow him to heal and eat. Video courtesy of Dawn Sears, MD, and Dan C Cohen, MD, Division of Gastroenterology, Scott & White Healthcare.
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This video, captured via esophagoscopy, shows band ligation of esophageal varices. Video courtesy of Dawn Sears, MD, and Dan C Cohen, MD, Division of Gastroenterology, Scott & White Healthcare.
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This video, captured via esophagoscopy, shows band ligation of esophageal varices. One of the varices has a red wale sign, which is a sign of recent bleeding. Video courtesy of Dawn Sears, MD, and Dan C Cohen, MD, Division of Gastroenterology, Scott & White Healthcare.
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This video shows circumferential Barrett esophagus via esophagoscopy. The HALO 360 device is in the esophageal lumen ready to perform radiofrequency ablation. Video courtesy of Dawn Sears, MD, and Dan C Cohen, MD, Division of Gastroenterology, Scott & White Healthcare.
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This video, captured via esophagoscopy, shows the Barrett esophagus after having just undergone a treatment with radiofrequency ablation using the HALO 360. Video courtesy of Dawn Sears, MD, and Dan C Cohen, MD, Division of Gastroenterology, Scott & White Healthcare.
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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.
