Esophagoscopy Technique

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

Standard Approach

With the patient properly positioned and sedation accomplished, the scope is inserted into the oropharynx with visualization of the epiglottis and vocal cords. The scope is then advanced through the piriformis sinuses and into the esophageal lumen. Air is insufflated to distend the esophageal lumen. Careful inspection of the esophagus is then accomplished, and the findings are photodocumented.

The video below shows an example of pediatric esophagoscopy.

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.

Diagnostic and therapeutic applications of esophagoscopy include the following:

  • Obtaining biopsies (see the first video below)
  • Banding esophageal varices (see the second, third, and fourth videos below)
  • Food bolus or foreign object retrieval using nets, baskets, forceps, and snares
  • Cauterization and endoscopic clip deployment
  • Dilations using balloon or savory dilators (see the fifth video below)
  • Performing injections
  • Deploying stents (see the sixth video below)
  • Resecting and/or ablating mucosal tissue (see the seventh, eighth, ninth, and 10th videos below)
  • Deploying and/or inserting instruments such as capsules and tubes
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.
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.
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.
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.
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.
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.
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.
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.
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.

The videos below depict normal findings on esophagoscopy.

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.
This video shows esophagoscopy with normal findings. Video courtesy of Dawn Sears, MD, and Dan C Cohen, MD, Division of Gastroenterology, Scott & White Healthcare.
This video shows esophagoscopy with normal findings. Video courtesy of Dawn Sears, MD, and Dan C Cohen, MD, Division of Gastroenterology, Scott & White Healthcare.
This video shows esophagoscopy with normal findings. Video courtesy of Dawn Sears, MD, and Dan C Cohen, MD, Division of Gastroenterology, Scott & White Healthcare.

Once the procedure is completed, the endoscope is removed from the patient, and the patient is monitored postprocedurally for any possible complications and allowed to recover from sedation. If the procedure was performed in the outpatient setting, the patient is discharged from the endoscopy unit with an escort after approximately 1 hour.

Next:

Alternative Approaches

Transnasal esophagoscopy is a procedure in which an ultrathin 4-mm flexible endoscope is introduced into the esophagus through the nares. It is a safe and well tolerated procedure that can be performed without sedation in an office-based setting. Transnasal esophagoscopy has been shown to have good results in visualizing the esophageal mucosa; however, its main limitation stems from the small channel caliber, through which it is not possible to pass many of the instruments necessary to perform therapeutic interventions. [2, 12, 13]

Esophageal capsule endoscopy is a procedure in which a capsule the size and shape of a pill with a tiny camera is swallowed by the patient. Multiple images of the esophagus are then obtained for viewing. The procedure does not require sedation and is therefore safer for the patient than traditional esophagoscopy is.

Additionally, esophageal capsule endoscopy has been shown to yield improved patient tolerance and therefore may have implications with regards to patient willingness to proceed with endoscopic screening and surveillance. This has especially been studied in the setting of esophageal varices. Multiple studies have shown that esophageal capsule endoscopy is good at detecting esophageal varices. [13, 14, 15, 16, 17, 18]  In a multicenter trial that evaluated 288 patients undergoing screening or surveillance for esophageal varices with both traditional upper endoscopy and esophageal capsule endoscopy, overall agreement for detecting varices was 85.8% between the two procedures. [19]

Previous
Next:

Complications

Esophagoscopy is considered a safe procedure with a complication risk of approximately 1 per 1000 procedures. Mortality is in the range of 0.5-3 deaths per 10,000 procedures. [10, 11, 20]  Common complications include the following [21] :

  • Bleeding
  • Infection
  • Perforation
  • Cardiopulmonary problems
  • Adverse reaction to medications

Aspiration, oversedation, hypoventilation, and airway obstruction account for more than 50% of major complications related to upper endoscopy. [22, 23]

Previous