How to examine the esophagus? How to examine the esophagus

Esophageal diseases are becoming more and more common nowadays, the most serious of which is esophageal cancer. Esophageal cancer can be diagnosed through esophagoscopy. Other examinations of the esophagus include esophageal barium meal fluoroscopy and ultrasound examination. Abnormal conditions in the esophagus must not be ignored and must be checked and treated in time to avoid serious conditions.

1. How to check the esophagus

There are three methods for examining the esophagus, namely, esophageal barium meal fluoroscopy, esophagoscopy and ultrasound examination.

In order of accuracy, from high to low, it is esophagoscopy --- esophageal barium meal --- ultrasound;

Sort by price, from high to low: esophagoscopy --- ultrasound --- esophageal barium meal;

In order of convenience and painlessness, they are ultrasound --- esophageal barium meal --- esophagoscopy.

2. Esophagoscopy

Esophagoscopy is a method of examining and treating lesions by inserting an esophagoscope into the esophagus. Like bronchoscopes, esophagoscopes come in two types: rigid tube and flexible tube. It is not advisable to conduct examination on patients with severe cardiovascular disease, severe esophageal varices, acute stage of esophageal corrosion injury, or critically ill patients.

(1) Instrument preparation: Currently, oval or oblate esophagoscopes are mostly used. Fiberoptic esophagoscopes are soft and bendable, with strong illumination and a wide field of view. They can observe subtle lesions, have a high diagnostic rate, cause little pain to patients, are not restricted by spinal deformities, and are relatively easy to operate. However, they are more difficult to use for treatment and to remove foreign bodies. Clinically, it is divided into two types: for adults and for children.

(2) Operation procedure: The operation is generally performed in a "high-low position" and the patient's head position is the same as that of direct laryngoscopy. The head should be 15 cm higher than the table surface. First, insert the esophagoscope along the right side of the mouth into the pyriform sinus on the right side of the laryngopharynx. Then gradually move the distal end of the esophagoscope toward the midline. Push the tube end forward and downward behind the arytenoid cartilage to reach the esophageal opening. At this time, the cricopharyngeal muscle can be seen bulging on the posterior wall like a threshold. Wait for the esophageal opening to open automatically, or ask the patient to swallow. After seeing the gap at the entrance of the esophagus clearly, immediately guide the tube end into the esophagus. Because the posterior wall is the thinnest at this point, be careful not to push it in blindly without waiting for the esophageal opening to open, so as to avoid esophageal perforation. After the esophagoscope enters the middle esophagus, the head should be gradually lowered and slightly tilted to the right to adapt to the rightward direction of the esophagus. The thoracic esophagus is wider than the cervical esophagus. Pulsation can be seen in the left front of the esophagus where the esophagus crosses the aorta. This should be noted during the examination. When examining the lower esophagus, the patient's head is usually 2 to 5 cm lower than the operating table.

During esophagoscopy, the direction of the endoscope tube should always be kept consistent with the lumen, and the esophagus should be moved forward while the front, back, left, and right walls can be clearly seen. It should not be biased to one side to avoid increasing the chance of esophageal wall damage.

Normal esophageal mucosa is smooth, moist, soft and light red. Care should be taken to observe whether the mucosa has congestion, ulcers, tumors, varicose veins, and whether the lumen is narrowed or dilated.