Esophagoscopy is an endoscopic procedure that permits visualization of the internal lumen of the esophagus. It is usually accomplished as a part of a more extended procedure called esophagogastroduodenoscopy (EGD), which includes the stomach and duodenum. This visual examination is performed by using a specially designed endoscope (flexible or rigid). Since its invention by Philip Bozzini in 1806, the endoscope, which at that time consisted of a rigid tube, external light source, and a viewer, has evolved to become smaller, flexible, and more versatile. Currently, flexible endoscopes are equipped with video imaging systems that generate magnified, clear images that can be viewed by the entire operating room staff and preserved in the medical record. Although flexible esophagoscopy can be performed with topical anesthesia, conscious sedation, or general anesthesia, rigid esophagoscopy is usually performed with the patient under general anesthesia.
Esophagoscopy is the primary diagnostic tool for any disease suspected to involve the esophagus. It also can be used for many different therapeutic applications, including delivery of ablative energy (cautery and photodynamic or laser therapy) for tumors, banding of varices, cauterization or injection for bleeding, deployment of stents, removal of foreign objects, and other surgical manipulations. Expertise in esophagoscopy is a requisite for all esophageal and general thoracic surgeons, and guidelines for skill attainment have been established and published by a number of surgical societies.1–5
The modern endoscopic system consists of an endoscope, light source, optical system, and working port. A basic understanding of these components, outlined in Table 14-1, is essential. For most applications, a flexible videoendoscope is sufficient and preferred. Flexible endoscopes come in many sizes. The larger sizes allow for wider suction and working ports while providing excellent images. They can be made even larger by using an over tube covering the scope and allowing for specific procedures. The smaller sizes are more comfortable for the patient and allow sufficient room for additional devices to be placed through the lumen of the esophagus at the same time. Certain light systems can be added to highlight desirable types of cells, such as in Barrett esophagitis. Rigid esophagoscopes are large, inflexible metal cylinders that come in different widths and lengths. These are used only for work that requires a very wide lumen, such as removing a foreign object or repositioning certain types of stents.
Table 14-1COMPONENTS OF AN ENDOSCOPIC SYSTEM