Oesophagoscopy – rigid scope

Before you agree to have an oesophagoscopy performed on your gullet it is sensible to know all you can about it. The information here is a guide to common medical practice. Each hospital and doctor will have slightly different ways of doing things, so you should follow their guidance where it is different from the information given here. Because all patients, conditions and treatments vary it cannot cover everything. Use this information when making your gullet treatment choices with your doctors. You should mention any worries you have. Remember that you can ask for more information at any time.

 

 

You may have difficulty swallowing or have discomfort in your throat or chest. There may be a problem inside your gullet (oesophagus). We need to look inside your oesophagus with a special telescope, called an endoscope, to find out what has gone wrong. The endoscope we use may also be called an oesophagoscope.

 

The oesophagus is the muscular tube that carries food and drink from the back of the throat down to the stomach. The oesophagus is also called the gullet. It passes behind the voice box. It has a delicate lining rather like skin, called mucous membrane. Secretions from the mucous membrane lubricate food as it passes from the mouth to the stomach.

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There is a weak valve at the lower end of the oesophagus, where it enters the stomach. This valve is called the cardiac sphincter. The cardiac sphincter prevents food, drink and stomach juices from flowing back up into the oesophagus, unless you vomit. The oesophagus is part of the digestive system, called the gastrointestinal tract.

 

There may be something blocking the oesophagus, such as food or a swallowed coin. There may be a narrowing (stricture), a thickening of the wall of the oesophagus or something pressing on the oesophagus from inside the chest. Sometimes the lining of the oesophagus becomes inflamed and sensitive. This may be because the cardiac sphincter is letting irritating stomach juices leak up into the oesophagus. Rarely, the cardiac sphincter muscle is too weak or overactive so it does not work properly. A pouch (diverticulum) in the wall of the oesophagus may be causing the problem.

 

The main aim of the procedure is to examine the inside of the oesophagus. The surgeon passes a special telescope down the back of the throat into the oesophagus. This instrument is called an oesophagoscope or scope for short. Some scopes are rigid metal tubes and others are flexible. With a flexible scope, the surgeon can usually examine the back of the throat and the inside of the stomach, as well as the oesophagus.

 

The surgeon can use the scope to inspect all the different parts in detail. If there is anything blocking the oesophagus, the surgeon can usually remove the blockage using fine grasping instruments passed down the scope.

 

The surgeon can remove small pieces of any diseased lining of the oesophagus by passing other instruments down the scope. The specimens are called biopsies. They are sent to the laboratory for tests. Biopsies are very small and the lining of the oesophagus heals quickly without stitches.

 

If there is a narrowing (stricture) in the oesophagus, the surgeon may be able to stretch it open by passing special balloons or stretching instruments, called bougies, down the scope. This is called oesophageal dilatation.

 

You will have a general anaesthetic and be completely asleep while the operation is done.

 

This examination of the oesophagus will help to find out if anything has gone wrong. We may also be able to treat the problem through the scope. The examination may tell us that all is well with your oesophagus.

 

X‑rays are not very good for showing the inside of the oesophagus. It is possible to use a barium swallow or a barium meal to outline the oesophagus on an x-ray. These x-ray examinations outline the oesophagus using barium liquid, which shows up on x-rays.

 

Both of these techniques are explained in depth in separate information leaflets within this series.

 

The main aim of this examination is to identify the problem with your oesophagus. It would not be safe to start treatment with tablets and medicines if the cause of your problem is not clear.

 

If there is a serious problem in your oesophagus, you may miss out on important treatment by just waiting and seeing. If you cannot swallow, you will rapidly become short of food and liquids. You may get an overspill of liquid from the oesophagus into the lungs, which can be very dangerous.

 

People with throat problems or swallowing difficulties should have an oesophagoscopy if there is doubt about the cause.

 

People who have other medical conditions that would make it unsafe for them to have a general anaesthetic should not have one.

 

There is a procedure that uses a thinner, flexible scope. This procedure can be done under sedation and local anaesthetic. The procedure is usually called a gastroscopy or upper GI endoscopy because the scope is also used to examine the stomach. This flexible oesophagoscopy may be done as an alternative if you are not fit for a general anaesthetic. It may also be done instead of using the rigid scope at the preference of your surgeon. This depends on your symptoms and the possible cause. If you are to have this flexible endoscopy (gastroscopy), it is covered in a separate information leaflet within this series.

 

People with severe curvature of the spine should not have a rigid oesophagoscope passed.

 

Author: Mr Robert Ruckley MB. ChB.  F.R.C.S.  Consultant ENT surgeon.

© Dumas Ltd 2006

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