Name of the Procedure:

Esophagoscopy, rigid, transoral; with directed submucosal injection(s), any substance

Summary

Esophagoscopy is a procedure where a rigid scope is inserted through the mouth to examine the esophagus. During this procedure, substances can be injected into the submucosal layer of the esophagus to address specific medical issues.

Purpose

This procedure is used to diagnose and treat conditions affecting the esophagus. It allows for direct visualization of the esophagus and can help manage issues like esophageal strictures or tumors by injecting therapeutic substances.

Indications

• Difficulty swallowing (dysphagia)
• Suspected esophageal tumors
• Esophageal strictures or narrowing
• Unexplained chest pain
• Persistent esophageal symptoms not resolved by other treatments

Preparation

• Patients are typically required to fast for 6-8 hours prior to the procedure.
• Medications may need to be adjusted or paused, as advised by the healthcare provider.
• Pre-procedure diagnostic tests like barium swallow or esophagram may be necessary.

Procedure Description

1. The patient is placed under general anesthesia or deep sedation.
2. A rigid esophagoscope is gently inserted through the mouth down into the esophagus.
3. The physician visually examines the esophagus.
4. Target areas within the esophagus are identified.
5. Directed submucosal injections of specific substances (such as botulinum toxin, corticosteroids, or saline) are administered to treat the identified issues.
6. The scope is carefully withdrawn after the necessary interventions.

Duration

The procedure typically takes 30-60 minutes.

Setting

Performed in a hospital endoscopy suite, outpatient clinic, or a specialized surgical center.

Personnel

• Gastroenterologist or surgeon experienced in endoscopic procedures
• Anesthesiologist or nurse anesthetist
• Endoscopy nurses and technicians

Risks and Complications

• Sore throat or discomfort post-procedure
• Bleeding at the injection site
• Perforation or tear of the esophagus (rare)
• Adverse reactions to anesthesia or sedation
• Infection

Benefits

• Accurate diagnosis of esophageal conditions
• Relief of symptoms such as difficulty swallowing
• Minimally invasive compared to open surgery
• Quick recovery time, often resuming normal activities within a day or two

Recovery

• Patients are observed for a few hours post-procedure for any immediate complications.
• Instructions typically include drinking clear fluids initially, then gradually resuming a normal diet.
• Avoid strenuous activities for 24-48 hours.
• Follow-up appointments to monitor progress and any secondary treatments if necessary.

Alternatives

• Flexible esophagoscopy, which uses a more flexible scope but may not be suitable for all patients or conditions.
• Barium swallow radiography for diagnostic purposes.
• Medications or lifestyle changes can be explored depending on the condition.
• Open surgical procedures for severe cases or when endoscopy is not feasible.

Patient Experience

• During the procedure, patients will be under anesthesia and should not feel any pain.
• Post-procedure, patients may feel mild throat discomfort or soreness.
• Pain management typically involves over-the-counter pain relievers and soothing throat lozenges.
• Patients are usually able to go home the same day after the effects of anesthesia wear off.