This document discusses various endoscopic procedures including laryngoscopy, bronchoscopy, and esophagoscopy. It provides indications for direct laryngoscopy including diagnostic examination and biopsy of suspected laryngeal malignancies as well as therapeutic procedures like foreign body removal. Micro-laryngoscopy is described as providing better illumination and precision compared to direct laryngoscopy but with some tradeoffs. Rigid and flexible bronchoscopy techniques are outlined noting rigid bronchoscopy allows procedures like foreign body removal but is more risky while flexible bronchoscopy can reach further into the lungs but not remove foreign bodies. Similarly, advantages and disadvantages of rigid versus flexible esophagoscopy are compared. Specific endoscopy positions, anatomy visualized, instruments used and potential complications are described

1. Laryngoscopy, Bronchoscopy
and esophagoscopy
Dr. Krishna Koirala
2020-04-15

2. Indications for Direct Laryngoscopy
Diagnostic
• Biopsy of suspected malignancy in
larynx and pyriform fossa
• Examination of hidden areas:
anterior commissure, laryngeal
ventricle, subglottis, infrahyoid
epiglottis, pyriform fossa apex
• Unsuccessful indirect laryngoscopy
Therapeutic
• Foreign body removal from
larynx and pyriform fossa
• Excision biopsy of benign
laryngeal lesion
• Dilatation of laryngeal
stricture

3. Micro-laryngoscopy Direct
Laryngoscopy
Binocular vision Monocular vision
Better illumination Less illumination
Magnification No magnification
Better precision Less precision
Both hands are free 1 hand holds scope
Video attachment possible No
Can be combined with microscopic
Laser
No

4. Direct Laryngoscopes and micro laryngoscopes

5. Boyce’s Endoscopy position
Supine position with head elevated by 10 cm

6. Tongue Base visualized

7. Epiglottis visualized

8. Vocal cords visualized

9. Laryngoscope fixed for microlaryngoscopy

10. Microscope focused

11. Rigid Bronchoscopy

12. Indications for Bronchoscopy
• Broncho -alveolar lavage for C/S, AFB, cytology
• Biopsy of tracheo-bronchial tumours
• Investigation of chronic cough, hemoptysis, left
vocal cord palsy, atelectasis, obstructive
emphysema, mediastinal growths
• Removal of tracheo-bronchial foreign bodies
• Removal of retained respiratory secretions

13. Rigid Bronchoscopy Flexible
Also functions as airway No
Better for removal of foreign body No
Allows use of Laser No
Visualizes up to 3rd bronchial division 5th division
Not done under local anesthesia Done
Not done in cervical spine problems Done
More risky & traumatic Safer
Not done for trans- bronchoscopic biopsy Done

14. Rigid Bronchoscope

15. Close -up of proximal and distal end

16. Bronchoscope introduced

17. At laryngeal inlet

18. Epiglottis identified

19. Vocal cords identified

20. Scope passed through glottis after 900 rotation

21. Scope rotated back

22. Tracheal rings identified

23. Carina identified

24. Bronchopulmonary segments

25. Endoscopy position

26. Scope in Right bronchus

27. Scope in Right bronchus

28. Scope in Right bronchus

29. Scope in Left bronchus

30. Scope in Left bronchus

31. Scope in Left bronchus

32. Flexible Bronchoscope

33. Rigid Esophagoscopy

34. Indications for esophagoscopy
• Investigation of dysphagia, hematemesis, GERD,
neck node metastasis of unknown origin
• Esophageal foreign body removal
• Excision biopsy of benign esophageal lesions
• Dilatation of esophageal strictures
• Sclerotherapy for esophageal varices
• Insertion of palliative esophageal feeding tube

35. Rigid esophagoscopy Flexible
Better for cricopharynx examination No
Better for removal of foreign body No
Allows use of Laser No
Not good for lower esophageal examn Good
Not done under local anesthesia Done
Not done in cervical spine problems Done
More risky & traumatic Safer

36. Rigid Esophagoscope

37. Jackson scope Negus scope
Distal illumination Proximal illumination
No markings Marked
Narrow Broad
Constant diameter Tapered
Single bulb Double bulb

38. Epiglottis visualized

39. Right pyriform fossa

40. Cricopharyngeal sphincter

41. Upper esophagus

42. Middle esophagus

43. Lower esophagus

44. Complications of Rigid Esophagoscopy
• Injury to lips, teeth and tongue
• Vocal cord injury, dislocation of arytenoids
• Aspiration of gastric contents/bronchospasm
• Mucosal trauma/esophageal perforation
• Laryngeal edema
• Cervical spinal cord injury
• Cardiac complications: Tachycardia/arrythmia/HTN/MI
• Meckler's triad: Vomiting, severe chest pain, subcutaneous
emphysema ( forced esophageal perforation)