Oesophagoscopy

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1. OESOPHAGOSCOPY By Raafi Ul Basheer Zargar

2. INTRODUCTION TYPES INDICATIONS CONTRAINDICATIONS ANESTHESIA POSITION TECHNIQUE STRUCTURES SEEN POSTOPERATIVE CARE COMPLICATIONS OVERVIEW

3. IT’S A PROCEDURE TO EXAMINE THE OESHPHAGUS FOR DIAGNOSTIC AND THERAPEUTIC PURPOSES INTRODUCTION

4. 1.RIGID OESOPHAGOSCOPY 2.FLEXIBLE FIBREOPTIC OESOPHAGOSCOPY 3.TRANSNASAL OESOPHAGOSCOPY TYPES

5. TO INVESTIGATE CAUSE OF: -DYSPHAGIA -RETROSTERNAL PAIN -HAEMATEMESIS -SECONDARIES OF NECK DIAGNOSTIC INDICATIONS

6. -REMOVAL OF FOREIGN BODY -DILATATION OF THE OESOPHAGUS -ENDOSCOPIC Removal of benign lesions -insertion of Souttar’s or Mousseau - barbin tube in paLLIATIVE treatment of oesophageal ca -injection of oesophageal varices THERAPEUTIC

7. 1.TRISMUS 2.DISEASES OF CERVICAL SPINE 3.RECEDING MANDIBLE 4.ANEURYSM OF AORTA 5.HEART, LIVER OR KIDNEY DISEASES CONTRAINDICATIONS

8. PATIENT ADVISED NOTHING TO EAT 3 HOURS PRIOR TO THE PROCEDURE PATIENT PREPARATION

9. RIGID OESOPHAGOSCOPY TYPES

10. GENRAL ANESTHESIA WITH ENDOTRACHEAL INTUBATION ANESTHESIA POSITION SWORD SWALLOING POSITION

11. PROTECTION OF LIPS & TEETH LUBRICATION OF SCOPE HOLDING OF THE SCOPE IDENTIFICATION OF LARYNGOPHARYNX STRUCTURES ADVANCEMENT FURTHER INTO CRICOPHARYNGEAL SPHINCTER CROSSING AORTIC ARCH & LEFT BRONCHUS PASSING THE CARDIA & FOLLOWED BY WITHDRAWL TECHNIQUES

12. 1.FEATUERES OF OESOPHAGEAL PERFORATION- INTRASCAPULAR PAIN -SURGICAL EMPHYSEMA OF NECK -ABRUPT RISE IN TEMP. 2.DIET- SIPS OF PLAIN WATER FOLLOWED BY USUAL DIET POSTOPERATIVE CARE

13. 1.INJURY TO LIPS AND TEETH 2.INJURY TO ARYTENOIDS 3.INJURY TO PHARYNGEAL MUSCLES 4.PERFORATION OF ESOPHAGUS 5.COMPRESSION OF TRACHEA COMPLICATION

14. 1.More amenable to therapeutic indications especially removal of foreign bodies. 2.Better visualization of proximal one- third of esophagus . ADVANTAGES

15. 1.General anaesthesia. 2.More cost and morbidity to patient. 3.More complications such as 4.dental trauma and oesophageal perforation. 5.Concomitant examination of stomach and intestine not possible. 6.Not amenable to cases of trismus or cervical spine degenerative diseases. DISADVANTAGES

16. FLEXIBLE FIBEROPTIC ESOPHAGOSCOPY

17. POSITION LEFT LATERAL SUPINE POSITION WITH EXTENDED NECK ANESTHESIA PERFORMED UNDER LOCAL ANESTHESIA WITH OR WITHOUT SEDATION TECHNIQUE SAME AS RIGID ESOPHAGOSCOPY

18. 1.An outdoor procedure. 2.No general anesthesia . It is done under local anesthesia with or without intravenous sedation. 3.Less morbidity. 4.It can be done in abnormalities of spine or jaw. 5.Gastroscope allows examination of stomach and duodenum. 6.Good illumination and magnification. 7.Accurate diagnosis of the mucosal diseases. ADVANTAGES

19. 1.Narrow channel limits the size of instruments and removalof certain foreign bodies. 2.Foreign body cannot be retracted into the endoscope(like rigid esophagoscope) so more chances of injuringesophagus . 3.Laryngopharynx and proximal one- third esophagus (less distensible with insufflations) may not be examined adequately. DISADVANTAGES

20. TRANSNASAL OESOPHAGOSCOPY

21. ANESTHESIA TOPICAL 1.NOSE: 4% LIDOCAINE 2.OROPHARYNX:20% BENZOCAINE POSITION SEATED POSITION FACING EXAMINER

22. SCOPE PASSED ALONG FLOOR OF NOSE IPSILATERAL PYRIFORM SINUS ADVANCEMENT INTO ESOPHAGUS INSUFFLATION OF ESOPHAGUS FURTHER ADVANCEMNT OF SCOPE INTO STOMACH SCOPE RETROFLEXED TO SEE COMPLETE VIEW OF GE JUNCTION WITHDRAWL TECHNIQUES

23. 1.IMPROVED SAFETY 2.DECREASED OVERALL COSTS 3.PATIENT PREFERENCE ADVANTAGES

24. 1.MULTIPLE BIOPSIES 2.VESSEL LIGATIONS 3.MANY THERAPEUTIC INSTRUMENTS DISADVANTAGES

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