Technique of esophagus endoscopy
Last reviewed: 20.11.2021
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Endoscopist becomes the left, facing the subject. The head of the patient is slightly thrown back. On the fibro endoscope put on the mouthpiece, the assistant fixes the head of the patient. The endoscopist grasps the fibroendoscope with his right hand and holds it like a pencil. Before insertion into the esophagus of the endoscope, the distal end of it is slightly bent posteriorly, respectively, by the bend of the oropharynx. The patient is offered to make a swallowing movement at the height of a small breath. At this point, the endoscope is carefully advanced into the cavity of the esophagus. When passing from the pharynx to the esophagus, great caution must be exercised. In connection with the reduction of the lower constrictor of the pharynx, the narrowest, perstneglotochnoe narrowing of the esophagus is formed, the so-called mouth of the esophagus according to Killian, 23 mm in diameter and 17 mm in the anteroposterior direction. There is always some resistance, and therefore the instrument should be carried out smoothly, because possibly perforation of the esophagus. To facilitate progress, at the moment of the throat, the apparatus without violence is injected into the esophagus, releasing at that moment a lever that bends the end of the endoscope. In the pharyngeal cavity, the endoscope is inserted strictly along the midline. It should be remembered that the end of the device easily deviates from the middle line and can rest against the pear-shaped pocket of the pharynx, formed by the so-called lower-pharyngeal ridge - the fold of the mucous membrane on the inner surface of the esophagus, corresponding to the location of the metatarsal-luteal muscle. Violence in such cases is not permissible - we must carefully correct the situation.
As the patient makes swallowing movements, the endoscope is gently guided through the upper esophageal sphincter and then promoted under direct visual control. The free movement of the apparatus, the absence of coughing and sudden changes in the voice indicate the presence of it in the esophagus. During this period, only a bright red field of view is visible in the eyepiece.
In the cervical region of the esophagus, the longitudinal folds of the mucous membrane touch at their apices. Fold the folds and inspect the mucous membrane of this department is possible only with intensive air injection, it is difficult to achieve full wrinkle expansion. At the time when the esophagus easily disappeared under the action of air, we can say that the end of the endoscope reached the thoracic part of the esophagus. Here the mucous membrane becomes smooth, pink, the lumen of the esophagus acquires a rounded shape. Below the level of the arch of the aorta (at a distance of 25 cm from the edge of the upper incisors) the esophagus slightly deviates to the left and anteriorly. In the course of this deviation, the esophagoscope should be advanced. The passage of the esophagus through the diaphragm is determined by the characteristic ring-shaped narrowing of the esophagus and a small extension. The ventral part of the esophagus is well spread by air and represents a funnel, the bottom of which is the food-water-gastric transition. The endoscopic guideline of the latter is the Z-line (Figure 14) - the transition zone between the esophagus (its pink mucosa) and the stomach (red mucosa). Normally, the Z-line is located 0-2 cm above the cardia.
After free passage of the middle and lower part of the esophagus, the endoscopist can feel an easy resistance due to a spasm of the circular musculature of the cardiac part of the stomach. In this case, by pressing the can, introduce a small amount of air and move the endoscope deeper without violence. From the moment the endoscope passes through the esophageal-gastric passage into the stomach, air is periodically supplied, which ensures good visibility. At the same time, one can observe a gradual change in the color of the field of view: it pales, becomes orange-yellow and soon the image of the mucous membrane of the stomach appears. The introduction of excessive amounts of air into the stomach can cause the patient to have painful sensations, regurgitation, and vomiting.
Examination of the esophagus is carried out both during the endoscope to the stomach and during its withdrawal. For the successful diagnosis of various diseases in esophagoscopy, one should study not only the integrity of the mucous membrane, its color, mobility, folding, but also the function of the esophagus - the peristalsis of its walls, their variation depending on the respiration and contractions of the heart, the rigidity of the walls that do not straighten out when introducing air .
When using a fibroendoscope with side optics, it is not possible to visually monitor its progress along the esophagus (this part of the procedure is performed blindly). Therefore, if suspicion of a disease of the esophagus, the study should be carried out by an endoscope with end optics.