Name of the Procedure:

Esophagoscopy, flexible, transoral; diagnostic, including collection of specimen(s) by brushing or washing, when performed (separate procedure).

Common Name(s)

Flexible Esophagoscopy, Transoral Esophagoscopy

Summary

A flexible esophagoscopy is a diagnostic procedure in which a thin, flexible tube with a light and camera (endoscope) is inserted through the mouth to examine the esophagus. During the procedure, specimens may be collected by brushing or washing the esophageal lining for further analysis.

Purpose

The procedure is conducted to investigate symptoms related to the esophagus, such as difficulty swallowing, unexplained pain, or persistent heartburn. It can help diagnose conditions like esophagitis, strictures, tumors, or Barrett's esophagus. The goal is to identify any abnormalities in the esophagus and to collect samples for further testing if necessary.

Indications

• Difficulty swallowing (dysphagia)
• Persistent heartburn or acid reflux
• Unexplained chest pain
• Suspected esophageal tumors or growths
• Chronic cough or throat pain
• Unexplained weight loss

Preparation

• Fasting for at least 6-8 hours before the procedure, usually starting from midnight.
• Adjustments to medications as directed by the doctor, particularly blood thinners.
• Pre-procedure evaluations such as a physical examination and possibly blood tests.

Procedure Description

1. The patient is prepped and given a sedative or local anesthetic to minimize discomfort.
2. The flexible endoscope is gently inserted through the mouth and guided down the esophagus.
3. The camera transmits images to a monitor, allowing the physician to carefully examine the esophageal lining.
4. If necessary, tissue samples are collected using small brushes or washing techniques to obtain cells for cytological analysis.
5. The endoscope is then cautiously withdrawn.

Tools, Equipment, and Technology

• Flexible endoscope with an integrated camera and light source
• Brushes or washing tools for specimen collection
• Sedation or local anesthetics

Duration

The procedure typically takes about 15 to 30 minutes.

Setting

Flexible esophagoscopy is usually performed in an outpatient clinic, hospital, or specialized endoscopy center.

Personnel

• Gastroenterologist or specialized endoscopist
• Nurse or medical assistant
• Anesthesiologist or nurse anesthetist (if sedation is used)

Risks and Complications

• Mild discomfort or sore throat post-procedure
• Rare risks include bleeding, infection, or perforation of the esophagus
• Adverse reaction to sedation or anesthesia

Benefits

• Accurate diagnosis of esophageal conditions
• Collection of biopsy samples for further analysis
• Non-invasive with a relatively quick recovery time

Recovery

• Patients are monitored for a short time after the procedure until the effects of the sedation wear off.
• A sore throat or mild discomfort may persist for a day or two.
• Normal activities can typically be resumed within 24 hours, but specific instructions from the healthcare provider should be followed.
• Follow-up appointments may be necessary to discuss biopsy results if specimens were collected.

Alternatives

• Barium swallow X-ray
• CT or MRI scans
• Other types of endoscopy, such as rigid esophagoscopy

Pros and Cons of Alternatives

• Barium swallow X-ray: Less invasive but less detailed and does not allow for biopsy.
• CT or MRI scans: Non-invasive but may not provide as detailed information about the esophageal lining.
• Rigid esophagoscopy: More invasive and typically requires general anesthesia but may be necessary for certain procedures.

Patient Experience

• During the procedure, discomfort is minimized with sedation or local anesthetics.
• Post-procedure, the patient might feel groggy from the sedation and may experience a mild sore throat.
• Pain management includes over-the-counter pain relief if needed, and instructions for comfort measures such as throat lozenges.