EZOFAGOSKOPIYA

From Big Medical Encyclopedia

EZOFAGOSKOPIYa (Greek oisopha-g os a gullet + skopeo to consider, investigate) — a method of a research of a mucous membrane of a gullet by means of the esophagoscope.

AA. apply to diagnosis of diseases of a gullet (see). During E. carrying out other diagnostic and medical manipulations is possible (a biopsy, removal of foreign bodys from a gullet, a stop of bleeding from varicose veins of a gullet, opening of abscess, diathermocoagulation and electroscission of benign tumors of a gullet of the small sizes, a rekanalization and excision of tumors of a gullet for the purpose of recovery of its passability in inoperable cases, a section cicatricial strik-TUR’ bougieurage, etc.).

Contraindications to E. acute inflammatory diseases of a gullet, an aortic aneurysm, acute coronary insufficiency, the expressed cachexia, terminal states are.

The first attempt to examine a gullet by means of a metal tube was made in 1868 by A. Kussmaul.

In a crust, time the research is conducted by means of esophagoscopes of rigid and flexible designs. In most cases use flexible devices — ezofagofibroskopa, to-rye unlike rigid are characterized by small injury, good maneuverability, high resolving power of the optical device, and also have the channel for introduction of various tools. The device of an ezofagofibroskop on a fiber optics same as gastrofibroskopa (see an astroskopiya). Rigid esophagoscopes use only in some cases, usually at extraction of rough foreign bodys of a gullet (see. Foreign bodys). The rigid esophagoscope consists of a set of metal tubes, the lighter and the handle, on the device does not differ from a bronkhoezofagoskop (see). Now produce the extended models of endofiberscopes with the direct review for simultaneous survey of a gullet, a stomach and a duodenum.

The research is made on an empty stomach. In 30 — 40 min. prior to the procedure subcutaneously enter 0,5 — 1 ml of 0,1% of solution of Atropini sulfas and 1 ml

of 1 — 2% of solution of Promedolum. The root of language, a back wall of a throat and an entrance to a gullet are greased or irrigate 5% with solution of cocaine, 1 — 3% solution of Dicainum, 1 — 5% solution of lidocaine (xylocainum) or less toxic 2% solution of Pyromecainum.

The research by means of an ezofagofibroskop is carried out in position of the patient on the left side. The distal end of the device is bent according to an anatomic axis of a stomatopharynx and through the plastic mouthpiece which is previously inserted between teeth advance the device (slightly concerning a back wall of a throat) to the mouth of a gullet. Then ask the patient to make the deglutitory movement and the device freely enter into a gullet. Introduction of an ezofagofibroskop is carried out under control of sight, for the best review air is blown into a gleam of a gullet. There is a method of a retrograde ezofagoskopiya through a gastrostomy.

During the use of the rigid esophagoscope the research is conducted in various provisions of the patient: sitting on a low chair with the head which is thrown back back, in situation on spin, on the left side or in genucubital situation. At introduction of the rigid esophagoscope to a gullet it is necessary to use constant anatomic reference points. Adhering to the centerline of language, the device is entered to a uvula, then, having given to the tool vertical position, will see him more deeply, to an epiglottis. Wringing out a nadgortai-nickname of a kpereda, the tube of the esophagoscope is advanced down to an upper sphincter of a gullet, shaped by sockets and formed by folds of a mucous membrane. Through an esophageal sphincter the esophagoscope is carried out to the cervical department of a gullet representing a crack. Further advance of the device on a gullet does not present special difficulties, up to cardial department where the gullet is closed in the form of a funnel, forming the socket with accurately visible line of transition of a mucous membrane of a gullet to a mucous membrane of a stomach.

At survey of a gullet it is necessary to pay attention to character of a mucous membrane of a gullet (color, a skladchatost, erosion, ulcers, the centers of a necrosis), mobility of walls at inflation of air, a peristaltics, the respiratory movements and a pulsator-nye of fluctuation in the field of an aortic arch, existence of varicose veins, tumors and other features. In the color table to the article «Gullet» (t. 19, Art. 336, fig. 1 — 18) showed an endoscopic picture normal and at nek-ry diseases of a gullet.

At E. complications of varying severity — from small ruptures of a mucous membrane before full perforation of a wall with development of bleeding and copper-ast.inita are possible (see). In this regard it is necessary to enter the esophagoscope carefully, strictly under control of sight. The most dangerous place — the lower constrictor of a throat. Any violent advance in this zone even of a flexible ezofagofibroskop can cause damage. Are possible perforation and bleeding at bougieurage of cicatricial strictures and at a biopsy.

Features of an ezofagoskopiya at children. AA. at children carry out with the diagnostic and medical purpose. Use of a fiber optics allowed to narrow considerably a circle of contraindications to E. at children, to-ruyu the children who are in critical condition when also other tool methods of a research are contraindicated should not see off only.

AA. carry out by means of esophagoscopes of a rigid and flexible structure. Endofiberscopes are the most convenient. Diameter of a tube of the endofiberscope is chosen depending on age of the child and the nature of a disease (use tubes with a diameter up to 9 mm more often).

The choice of a method of anesthesia depends generally on type of the used device, age of the child and estimated duration of the procedure. So, the ezofagofibroskopiya at newborns and children of the first three months of life can be executed without anesthesia; at children aged from 4 months up to 7 years it will be out under anesthetic, an optimal variant to-rogo is the nasopharyngeal anesthesia using mix of oxygen, nitrous oxide and Ftorotanum, at children 7 years a research are more senior carry out under local anesthesia, however at serious condition of the patient prefer an anesthesia. AA. by means of esophagoscopes of a rigid structure at children of all age groups it is necessary to carry out under the combined endotracheal anesthesia. Technology of carrying out E. at children does not differ from that at adults.

Bibliography: V. M. brawlers, etc.

Endoscopy of abdominal organs, M., 1977; Inshakov JI. N, Alexandrova H. M and Shibanova A. I. Ezofagofibroskopiya in диаг^ to a nostika of cancer of gullet, Vopr. onkol., t. 20, No. 1, page 15, 1974; Onions -

with to and y G. I. and Berezov Yu. E. Endoskopicheskaya of the technician in surgery. M, 1967; B. S Rose trees. Foreign bodys and injuries of a gullet and related complications, M., 1961; Fedo

S. P. K ditch to recognition and treatment of diseases of a gullet, Russian doctor, t. 6, page 213. 1902; Gastroenterologische Endoskopie, hrsg. v. R. Ottenjann u. M. Classen, Stuttgart, 1979; Motility and its disturbances, ed. by A. M. Connell, L. — Philadelphia,

1982. See also bibliogr. to St. Gullet.

V. A. Romanov; S. S. Bridge (ped.).

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