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Esophagoscopy

By

Catherine Spader, RN

What is an esophagoscopy?

An esophagoscopy is a procedure that allows your doctor to examine the inside of your esophagus using a long thin instrument called an endoscope. The endoscope contains a light and a camera that transmits pictures of the inside of your esophagus to a video screen. Esophagoscopy can help diagnose and treat diseases and disorders of the esophagus, such as esophageal cancer, Barrett’s esophagus, and objects stuck in the esophagus.

The esophagus is a muscular tube located in the upper gastrointestinal tract that connects your mouth to your stomach. An esophagoscopy can help your doctor diagnose unexplained symptoms you may be having, such as difficulty swallowing, upper abdominal pain, vomiting blood, or regurgitation. An esophagoscopy can also show certain structures of the throat and larynx (voice box).

Esophagoscopy is a minimally invasive procedure that can often be performed in an outpatient setting. The procedure does not require an incision and generally has a quick recovery and a very low risk of complications.

Esophagoscopy is only one method used to treat and diagnose conditions of the esophagus. Ask your doctor or healthcare provider about all of your options to understand which option is best for you.

Types of esophagoscopy

The types of esophagoscopy include:

  • Flexible esophagoscopy is performed by inserting a thin, flexible endoscope through the mouth and down the throat into the esophagus.

  • Transnasal flexible esophagoscopy is performed by inserting a thin, flexible endoscope through the nose and down the throat into esophagus.

  • Rigid esophagoscopy is performed by inserting a rigid endoscope through the mouth and down the throat into the esophagus.

Other procedures that may be performed

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Your doctor may recommend one or more additional procedures during your esophagoscopy to diagnose or treat certain conditions. The following procedures may be performed during the esophagoscopy procedure:

  • Botulinum toxin injection into the lower esophageal sphincter to relieve difficulty swallowing due to hypertensive lower esophageal sphincter

  • Chromoendoscopy, which involves spraying dye into the esophagus to highlight abnormal tissue

  • Dilation of the esophagus that is too narrow, often due to scar tissue

  • Endoscopic injection therapy, which is the application of medication that shrinks esophageal varices (enlarged veins in the esophagus that can bleed)

  • Endoscopic mucosal resection (EMR), which is the removal of abnormal lesions through an endoscope in early stage esophageal cancer or Barrett's esophagus

  • Fluorescence spectroscopy to identify esophagus tissue that may be cancerous

  • Foreign body removal, or removal of food or other object that is stuck in the esophagus

  • Photodynamic therapy for treatment of esophageal cancer with a laser directed through an endoscope

  • Radiofrequency ablation (RFA), which involves the use of heat to destroy abnormal cells from Barrett’s esophagus

  • Tissue biopsy, which involves removing samples of abnormal-looking intestinal tissues to be examined for disease or cancer

  • Variceal ligation for treatment of esophageal varices by tying them off with elastic bands

Why is an esophagoscopy performed?

Your doctor may recommend an esophagoscopy to diagnose and possibly treat a variety of diseases and conditions of the esophagus, and sometimes the throat and larynx (voice box). These include:

  • Acid reflux, gastroesophageal reflux disease (GERD), hiatal hernia, laryngopharyngeal reflux, or heartburn

  • Barrett’s esophagus, which is damage to the esophagus caused by stomach acid

  • Cancer, tumor, or mass of neck, throat, airway, or esophagus

  • Chronic cough or hoarseness due to such conditions as acid reflux or GERD

  • Difficulty swallowing (dysphagia), painful swallowing (odynophagia) and esophageal motility disorders, such as hypertensive lower esophageal sphincter, or difficulty feeding and regurgitation in infants

  • Esophageal varices, which are swollen veins in the esophagus that can bleed

  • Foreign body evaluation and removal

  • Globus sensation, which is a feeling of a lump in the throat

  • Narrowing or compression of the esophagus due to such conditions as scar tissue or a muscle disorder

  • Trauma to the esophagus, such as a tear or injury from violent and repeated coughing or vomiting

  • Vomiting blood from such conditions as a bleeding ulcer in the upper gastrointestinal tract or veins in the esophagus

Who performs an esophagoscopy?

The following specialists commonly perform esophagoscopy:

  • Gastroenterologists are internists who specialize in diseases of the digestive system.

  • Pediatric gastroenterologists specialized in diagnosing and treating digestive system and nutritional problems in children.

Other specialists who perform esophagoscopies include:

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  • General surgeons and pediatric surgeons specialize in the surgical treatment of a wide variety of diseases, disorders and conditions.

  • Otolaryngologists and pediatric otolaryngologists specialize in treating conditions of the ears, nose and throat. They are also called ENTs.

How is an esophagoscopy performed?

The technique used to perform your esophagoscopy will vary depending on the specific procedure, your symptoms or diagnosis, and other factors. General steps are provided for specific procedures.

Flexible esophagoscopy

Flexible esophagoscopy is often performed in a doctor’s office, outpatient surgical center, or a procedure room in a hospital. It generally takes half an hour or less and includes these steps:

  1. You dress in a patient gown. Your care team positions you on an examination table. Your care team will give you blankets for modesty and warmth as needed.

  2. Your doctor or care team sprays a topical anesthetic into the back of your throat to numb it and reduce the gag reflex. Your doctor also gives you a light sedative to make you drowsy and relaxed, and possibly a pain medication. Medication may be given intravenously (through an IV). In some cases, deeper sedation or anesthesia may be used in which you are more relaxed and unaware of the procedure. You may not even remember it. Your care team monitors your vital signs during IV sedation.

  3. Your doctor has you wear a special mouth guard to protect your teeth during the procedure.

  4. Your doctor inserts a thin, flexible endoscope through your mouth or nose, through the throat, and into the esophagus. The doctor takes pictures and the images are transmitted onto a video screen. You may be asked to swallow at certain times to help guide the endoscope into the esophagus.

  5. Your doctor pulls the endoscope out of the esophagus. This is when the most careful examination is carried out and procedures, such as tissue biopsy and treatments, are generally performed.

Rigid esophagoscopy

Rigid esophagoscopy is generally performed in a hospital. This procedure is often done under general anesthesia and takes about one hour. The day of your procedure, you can generally expect to:

  1. Talk with a preoperative nurse. The nurse will perform an exam and ensure that all needed tests are in order and that you understand and sign the surgical consent form.

  2. Remove all clothing and jewelry and dress in a hospital gown. It is a good idea to leave all jewelry and valuables at home or with a family if possible. Your care team will give you blankets for modesty and to keep you warm.

  3. Talk with the anesthesiologist or nurse anesthetist about your medical history and the type of anesthesia you will have.

  4. Your care team starts an IV and gives you a combination of IV drugs and inhaled gases. You will not feel or remember the procedure as the rigid endoscope is passed into the esophagus.

  5. Your care team monitors your vital signs and other critical body functions. This occurs throughout the procedure and your recovery until you are alert, breathing effectively, and your vital signs are stable.

Will I feel pain?

Your comfort and relaxation is very important to both you and your care team. You may feel pressure in your throat and you will not be able to talk during the procedure. Your care team will give you pain and sedative medications to keep you calm and comfortable. In fact, patients often fall asleep during the procedure. You will not feel or remember the procedure if you have general anesthesia.

What are the risks and potential complications of an esophagoscopy?

Complications after an esophagoscopy are not common. However, any procedure involves risks and the possibility of complications that may become serious in some cases. Complications can develop during the procedure or recovery. Risks and potential complications of an esophagoscopy include:

  • Adverse reaction or problems related to anesthesia, sedation or medications, such as an allergic reaction and problems with breathing.

  • Bleeding

  • Difficulty swallowing and sore throat

  • Esophageal perforation or tear

  • Fever

  • Infection

  • Injury to your teeth, jaw joint, lips, or throat

  • Pain

  • Subcutaneous surgical emphysema, which is air trapped under the skin.|

Reducing your risk of complications

You can reduce the risk of certain complications by:

  • Following activity, dietary and lifestyle restrictions and recommendations before your procedure and during recovery

  • Notifying your doctor immediately of any concerns, such as bleeding, fever, or increase in pain

  • Taking your medications exactly as directed

  • Telling all members of your care team if you have any allergies

How do I prepare for my esophagoscopy?

If you dread the thought of undergoing an esophagoscopy procedure, you are not alone. You are an important member of your own healthcare team. The steps you take before your procedure can improve your comfort and outcome. You can prepare for an esophagoscopy by:

  • Answering all questions about your medical history and medications you take. This includes prescriptions, over-the-counter drugs, herbal treatments, and vitamins. It is a good idea to carry a current list of your medical conditions, medications, and allergies at all times.

  • Completely following all your doctor’s specific instructions. This generally includes not eating or drinking anything from four to eight hours before the procedure. You may also need to take a medication before the procedure to dry your mouth and air passages.

  • If you wear dentures, you will need to remove them for the procedure. It is a good idea to leave them with a family member or at home if possible.

  • Taking or stopping medications exactly as directed. For an esophagoscopy, this may include not taking aspirin, ibuprofen (Advil, Motrin), and blood thinners. You doctor will give you instructions for taking or discontinuing your specific medications and supplements.

Questions to ask your doctor

Preparing for an esophagoscopy can be stressful. It is common for patients to forget some of their questions during a doctor’s office visit. You may also think of other questions after your appointment. Contact your doctor with concerns and questions before the procedure and between appointments.

It is also a good idea to bring a list of questions to your appointment. Common questions include:

  • Why do I need an esophagoscopy? Are there any other options for diagnosing or treating my condition?

  • How long will the procedure take? When can I go home?

  • What kind of restrictions will I have after the procedure and when can I expect to return to work and other activities?

  • What kind of assistance will I need at home? Will I need a ride home?

  • What medication plan should I follow before and after the procedure?

  • How will you manage my pain?

  • When should I follow up with you?

  • How should I contact you? Ask for numbers to call during and after regular hours.

  • When will I receive the results of my test?

What can I expect after my esophagoscopy?

Knowing what to expect after an esophagoscopy can help you get back to your everyday life as soon as possible.

How will I feel after the esophagoscopy?

You may have a sore throat, bloating, gas, and cramping after the procedure. These symptoms should be mild and brief. Call your doctor if they are not improving rapidly or are getting worse, because this can be a sign of a complication. You might also feel a little drowsy for about 24 hours from the anesthesia or sedative.

When can I go home?

You will need to stay in the doctor’s office, surgical outpatient facility, or hospital for a short period of time after your esophagoscopy. The length of time varies depending on your age, general health, and the specific type of procedure and anesthesia used.

If you are sedated, your doctor will discharge you home when you are alert, breathing effectively, and your vital signs are stable. This generally takes an hour or two, depending on the type of sedation. You will not be able to drive for about 24 hours after sedation. You will need a ride home from your procedure. Someone should stay with you for a day or so because you may still be a bit drowsy.

If you receive general anesthesia, you will stay briefly in the recovery room after the procedure until you are alert, breathing effectively, and your vital signs are stable. In some cases, you may be able to go home on the same day, but a hospital stay may be required.

When should I call my doctor?

It is important to keep your follow-up appointments after an esophagoscopy. Call your doctor if you have questions or concerns between appointments. Call your doctor if you have:

  • Bleeding, including bloody or black stools, rectal bleeding, or vomiting blood

  • Breathing problems, such as shortness of breath, difficulty breathing, labored breathing, or wheezing

  • Chest pain

  • Cough that does not go away

  • Fever

  • Pain or discomfort that gets worse or does not go away as expected

  • Sore throat or hoarseness that lasts longer than expected

Medical Reviewers: William C. Lloyd III, MD, FACS Last Review Date: Sep 9, 2016

© 2016 Healthgrades Operating Company, Inc. All rights reserved. May not be reproduced or reprinted without permission from Healthgrades Operating Company, Inc. Use of this information is governed by the Healthgrades User Agreement.

View Sources

Medical References

  1. Bleeding esophageal varices. MedlinePlus, a service of the National Library of Medicine National Institutes of Health. http://www.nlm.nih.gov/medlineplus/ency/article/000268.htm.
  2. Endoscopic Therapy May Offer An Alternative To Surgery In Patients With Esophageal Cancer. Science Daily. http://www.sciencedaily.com/releases/2008/10/081006092650.htm.
  3. Esophageal Cancer Screening. National Cancer Institute. http://www.cancer.gov/cancertopics/pdq/screening/esophageal/Patient/page3.
  4. Esophageal Diagnostic Procedures. Thoracic Surgery Directors Association. http://www.ctsnet.org/doc/4270.
  5. Lump in Throat. Merck Manual. http://www.merckmanuals.com/professional/sec02/ch007/ch007e.html.
  6. Photodynamic Therapy for Cancer. National Cancer Institute. http://www.cancer.gov/cancertopics/factsheet/Therapy/photodynamic.
  7. Shaheen, N.J. et al. Radiofrequency Ablation in Barrett's Esophagus with Dysplasia. N Engl J Med 2009;360:2277-2288. http://www.nejm.org/doi/full/10.1056/NEJMoa0808145#t=articleDiscussion.
  8. Transnasal Esophagoscopy (TNE). Columbia University. http://www.entcolumbia.org/tne.html.
  9. Upper GI Endoscopy. National Digestive Diseases Information Clearinghouse (NDDIC). http://digestive.niddk.nih.gov/ddiseases/pubs/upperendoscopy/.

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