What to do if your esophagus is blocked? Treatment for esophageal obstruction

If esophageal obstruction occurs, esophagoscopy should be performed promptly to confirm the condition. Esophagoscopy is suitable for patients with dysphagia or esophageal obstruction. A full-body examination should be performed during this examination. Patients with hypertension or heart disease should not undergo this examination.

1. Indications

(1) Patients with dysphagia or esophageal obstruction. 

(2) Patients suspected of esophageal cancer by X-ray barium meal examination. 

(3) Patients with local external pressure on the esophagus found during X-ray barium meal examination. 

(4) For patients who have undergone radiotherapy or surgical resection for esophageal cancer and are suspected of having a recurrence, microscopic examination can be used to confirm the diagnosis.

2. Contraindications

(1) Those with severe hypertension, heart disease, or cardiopulmonary insufficiency. 

(2) Aortic aneurysm compresses the esophagus. 

(3) If the lesion at the entrance of the esophagus has caused obstruction and the endoscope cannot pass through, making observation difficult, consider using a rigid esophagoscopy.

(4) Use with caution in patients with esophageal perforation caused by sharp foreign bodies or malignant lesions, as fiberoptic microscopy requires inflation with water, which can easily aggravate mediastinal infection.

3. Anesthesia and body position

(1) Anesthesia: Mainly local anesthesia, use 2-3 ml of 1% tetracaine, spray on the pharyngeal mucosa, and ask the patient to hold the liquid in his mouth and not spit it out. Spray again after an interval of about 3 minutes. The anesthetic effect can be achieved after 3 to 5 times. Finally, swallow the medicine. 

(2) Body position: After anesthesia, the patient lies on his left side with his legs naturally bent and his whole body relaxed.

4. Surgical steps

(1) The surgeon should first check whether the fiberscope light source, suction, air blowing, water injection and adjustment knobs are functioning normally. Then stand at the patient's head end, facing the patient, and ask the patient to gently bite the dental pad with the hole. The operator holds the operating part of the mirror with his left hand; with his right hand, bend the lens into an arc shape and send it into the mouth through the hole of the dental pad.

(2) Adjust the lower knob to straighten the lens, and gently push it downward along the posterior pharyngeal wall, observing as you advance. When you reach the esophageal opening in the hypopharynx, slightly apply pressure to the lens. When the esophageal opening opens or the patient swallows, the lens can smoothly enter the esophageal cavity.

(3) After entering the esophagus, an appropriate amount of gas is intermittently injected to expand the esophagus to ensure that the camera can be moved forward and the lesion can be observed under direct vision.

(4) First, send the camera to the cardia, then carefully observe each segment of the esophagus while withdrawing the camera. After the lesion is found, its length and distance from the incisor are measured, and then a biopsy is taken depending on the specific situation. Observe that there is no active bleeding and withdraw the fiberscope while suctioning.