An esophagoscopy is a medical procedure used to examine the lining of the esophagus, the muscular tube that carries food and liquid from the throat to the stomach. It is a type of endoscopy, using a long, thin, flexible tube called an endoscope, which has a light and a miniature video camera at its tip. The physician guides this instrument through the patient’s mouth or nose and down into the esophagus to visualize the inner surface on a screen. As a quick, minimally invasive procedure, an esophagoscopy is typically performed in an outpatient setting, allowing the patient to go home the same day.
Why This Examination Is Necessary
Doctors order an esophagoscopy to investigate persistent symptoms related to the upper digestive tract. It is necessary for diagnosing conditions that cause difficulty swallowing, resistant heartburn, or unexplained chest pain. The procedure allows for direct visualization of the esophageal lining, which is often more accurate than X-ray imaging for identifying problems.
The examination is commonly used to evaluate chronic conditions like gastroesophageal reflux disease (GERD) and its complication, Barrett’s esophagus. It can also help find the cause of upper gastrointestinal bleeding or persistent nausea and vomiting. The endoscope is equipped with channels that allow the physician to perform minor interventions.
These interventions include taking small tissue samples, known as biopsies, to test for inflammation or cancerous changes. The procedure is also used to remove foreign objects that have become lodged in the esophagus. Narrowed areas, called strictures, can be stretched open through dilation, which restores the normal passage of food.
How to Prepare
Preparation focuses on ensuring the esophagus and stomach are empty to allow for a clear view and prevent aspiration during sedation. Patients are required to stop eating solid food for at least eight hours before the procedure. Clear liquids, such as water or apple juice without pulp, can usually be consumed up to two hours prior to the appointment.
Management of existing medications must be discussed with the physician beforehand. Blood-thinning medications, such as aspirin or certain anticoagulants, may need to be temporarily stopped several days before the procedure to reduce the risk of bleeding, especially if a biopsy is planned. Patients with diabetes often require specific instructions about adjusting their insulin or oral medications on the day of the procedure.
Since the examination involves sedation, which temporarily impairs judgment and coordination, it is mandatory to arrange for a responsible adult to drive the patient home. The patient will not be permitted to drive, operate machinery, or take public transportation alone for the remainder of the day. Following these instructions is important for patient safety and to ensure the procedure can be performed.
What Happens During the Examination
Upon arrival, an intravenous (IV) line will be inserted to administer fluids and sedative medication. Sedation aims to make the patient comfortable, minimize anxiety, and reduce the gag reflex, often resulting in little memory of the procedure. Depending on the procedure, this may involve conscious sedation (drowsy but responsive) or deep sedation (fully asleep but not under general anesthesia).
The patient is generally positioned lying on their left side, which helps with the safe passage of the endoscope. A plastic mouth guard, or bite block, is placed between the teeth to protect the endoscope and the patient’s mouth. Once the sedation has taken effect, the physician gently guides the flexible endoscope through the mouth and into the esophagus.
Air is often pumped through the scope to gently inflate the esophagus and stomach, providing the physician with a better visual field of the lining. The physician carefully examines the tissue, and if any abnormalities are found, small instruments can be passed through the scope to collect biopsies or perform treatment. A diagnostic esophagoscopy is relatively quick, often lasting between 15 and 30 minutes.
Immediate Recovery and Follow-Up Care
After the procedure, the patient is moved to a recovery area for monitoring as the sedation wears off. Recovery staff monitors vital signs until the patient is awake and alert enough for discharge, which typically takes one to two hours. Patients may experience a mild, temporary sore throat due to the passage of the endoscope, which can often be soothed with gargling or cold liquids.
A common side effect is temporary fullness or bloating, caused by the air used to inflate the upper digestive tract. Due to the effects of the sedative medications, patients are restricted from driving, operating hazardous machinery, or making important legal or financial decisions for the following 12 to 24 hours. The physician may discuss initial findings before discharge, but final results from collected biopsies take longer to process. Tissue analysis typically requires one to three weeks before the complete results are available for a follow-up consultation.