The document provides a history of the development of endoscopy of the esophagus and related structures. It describes innovations from the early 19th century using candles for illumination to the modern development of flexible fiberoptic endoscopy in the 1960s. It also summarizes the anatomy of the esophagus including its parts, walls, blood supply, lymphatics and innervation. Finally, it discusses techniques for rigid and flexible esophagoscopy along with potential complications.

1. Oesophagoscopy

2. HISTORY OF AERODIGESTIVE
ENDOSCOPY
• In 1806,Bozzini fashioned an angled speculum with a mirror insert for
examination of the larynx, using a single wax candle for illumination.
• In 1829, Babbington described a glottiscope, a three-bladed device
including a stainless steel mirror and tongue retractors.
• Desmoreaux, the “father of endoscopy,” redesigned it in 1853 by
attaching a gaslight and condensers to project a beam of light down
the tube.

3. HISTORY OF AERODIGESTIVE
ENDOSCOPY
• Killian In 1897,developed a direct laryngoscope using a headlight for
illumination.
• He was the first to remove a foreign body in the bronchial tree using
direct upper bronchoscopy.
• In the early 1900s, Chevalier Jackson invented distal lighting for
endoscopic equipment, and designed a variety of endoscopic
instruments

4. HISTORY OF AERODIGESTIVE
ENDOSCOPY
• The use of magnification to enhance endoscopy was developed by
Brunings and Jackson.
• The addition of the Zeiss operating microscope for direct
pharyngolaryngoscopy was seen in the mid-1950s.
• Adolf Kussmaul was the first to use a straight tube after studying the
techniques of sword swallowers to visualize the osephagus.

5. HISTORY OF AERODIGESTIVE
ENDOSCOPY
• In the 1960s, flexible fiber-optic bronchoscopes were developed and
introduced into clinical use by Shigeto Ikeda.
• Fiber-optic esophagoscopes, shortly thereafter, came into use.

6. ANATOMY
• The esophagus is a vertical muscular tube that extends from the
hypopharynx to the stomach.
• 23 to 25 cm in length in the adult.2 cm Width.It’s Lumen is flattened
anteroposteriorly.Normally it’s kept closed (collapsed) and opens
(dilates) only during the passage of the food.
• The esophagus starts in the midline at the lower border of the cricoid
cartilage (C6), extending to the cardiac orifice of the stomach(T11).

7. • PARTS OF THE ESOPHAGUS
• The esophagus is split into the
following 3 parts
• Cervical part (4 cm in length).The
cervical part extends from the
lower border of cricoid cartilage
to the superior border of
manubrium sterni.

8. • Borders of cervical oseophagus
• Anteriorly by the trachea
• Posteriorly by the vertebral
column
• Laterally by the carotid sheaths
and the thyroid gland

9. • Thoracic part (20 cm in length)
• The thoracic part extends from superior border of manubrium sterni
to the esophageal opening in the diaphragm
• In the superior mediastinum, the esophagus is posterior to the
trachea and in contact with the common carotid arteries.
• The recurrent laryngeal nerves lie in the angle between the
esophagus and the trachea
• The thoracic duct lies on its left side

10. Thoracic part of oseophagus in superior
mediastinum

11. • The esophagus passes posterior and to the right of the aortic arch
and proceeds along the right side of the descending aorta.
• Inferior to the arch of the aorta, the left bronchus crosses and indents
the esophagus anteriorly.
• The thoracic duct is posterior to the lower portion of the esophagus,
and the azygos vein is to the right side of the esophagus in the thorax.
• The right vagus nerve descends posterior to and the left vagus
descends anterior to the esophagus

12. Thoracic part of oseophagus in posterior
mediastinum

13. • Abdominal part (1-2 cm in
length).
• The abdominal part extends
create esophageal opening in
the diaphragm to the cardiac
end of the stomach.
• The short abdominal part of the
oesophagus (about 1 cm) forms
a groove in the left lobe in the
liver.

14. Anatomical Position
• The oesophagus begins in the
midline at the level of the lower
cricoid border (C6).
• It then deviates to the left at the
root of the neck.
• It returns to the midline in the
mediastinum at T5.

15. • When it reaches T7, it once
again deviates to the left to
reach the gastric cardia.
• It passes anteriorly into the
oesophageal hiatus of the
diaphragm at T10.
• It ends at the level of T11 in the
gastric cardiac orifice

16. Topography and Constrictions of Esophagus
• The distance of each constriction is measured from the upper incisor
teeth.
15 cm

18. CLINICAL IMPORTANCE OF
ESOPHAGEAL CONSTRICTIONS
• The anatomical constrictions of esophagus are of considerable clinical
importance because of the following reasons.
• These are the sites where swallowed foreign bodies may stuck in the
esophagus.
• These are the sites where strictures develop after ingestion of caustic
substances.
• These are sites via which it might be difficult to pass
ophagoscope/gastric tube

19. The wall of the esophagus: four layers
• The esophagus is lined by nonkeratinizing stratified squamous
epithelium.It has a thin lamina propria layer.
• The muscularis mucosae are composed of smooth muscle fibers
• The submucosa consists primarily of thick collagenous and coarse
elastic fibers.It also contains mucous glands and Meissner’s plexus.
• The outer coat, or fibrosa, consists of loose fibroelastic tissue

20. Musculature of Esophagus
• The esophagus consists of
– Striated (voluntary) muscle in its upper third,
– Smooth (involuntary) muscle in its lower third,
– Mixture of striated and smooth muscle in between
• The muscle of the esophagus is composed of an inner circular layer
and an outer longitudinal layer.
• Auerbach’s myenteric plexus lies between the two muscle layers.

21. Musculature of Esophagus

22. Oesophageal Sphincters
• There are two sphincters present in the oesophagus, known as
–The upper upper esophageal sphincter is a high-pressure zone in
esophageal manometry and corresponds with the cricopharyngeal
muscle.
–The lower oesophageal sphincter is approximately 3 cm long.
• A single distinct muscle responsible for the lower sphincter action has
not been identified.

23. ARTERIAL SUPPLY
• A.The cervical part is by
– Inferior thyroid arteries
B.The thoracic part is by
– Esophageal branches of
– Descending thoracic aorta, and
– Bronchial arteries.

24. ARTERIAL SUPPLY
• C.The abdominal part is by
– Esophageal branches of
--Left gastric artery, and
--Left inferior phrenic artery

25. VENOUS DRAINAGE
• A. Cervical part is drained by
inferior thyroid veins.
• B. Thoracic part is drained by
azygos and hemiazygos veins.

26. VENOUS DRAINAGE
• C. Abdominal part is drained by
2 venous channels
• Hemiazygos vein, a tributary of
inferior vena cava.
• Left gastric vein, a tributary of
portal vein.
• Thus abdominal part of
esophagus is the site of
portocaval( porto-systemic )
anastomosis.

27. Lymphatics
• The lymphatic drainage of the
oesophagus is divided into thirds
• Superior third :Deep cervical
lymph nodes
• Middle third:Superior and
posterior mediastinal nodes

28. • Lower third:Left gastric and
celiac nodes

29. NERVE SUPPLY
• The esophagus is supplied by both parasympathetic and sympathetic
fibres.
• The parasympathetic fibres are originated from recurrent laryngeal
nerves and esophageal plexuses created by vagus nerves.
• They supply sensory, motor, and secretomotor supply to the
esophagus.

30. • The sympathetic fibres are
originated from T5-T9 spinal
segments are sensory and
vasomotor

31. Rigid esophagoscopy
• Indications
1. Exclude 2nd primaries in SCC of upper aerodigestive tract
2. Remove foreign bodies
3. Biopsy, dilate or stent tumours
4. Determine distal extent of hypopharyngeal and oesophageal
carcinoma
5. Dilate strictures
6. Exclude traumatic perforations with Penetrating injury of neck
7. Inject oesophageal varices

32. • 8.Blunt trauma to the neck with associated subcutaneous air
• 9..Radiographic evidence of esophageal masses or strictures.
• 1o.Congenital anomalies.
• 11.Vocal fold palsies

33. • 25cm rigid scope is usually
adequate

34. Technique
• Proximal oesophagus follows lordosis of Cervical & thoracic spine;
bring both into straight line by elevating head.
• The patient is placed in supine position with a pillow placed
underneath the shoulders and neck to achieve minor extension of
neck and marked head extension at the atlanto-occipital joint.
• Thumb of non-dominant hand as a fulcrum to protect teeth

35. • With neck extended, pass scope via
right corner and floor of mouth, and
follow lateral wall of right pyriform
fossa to its full depth.
• Readjusting scope to midline engages
larynx and elevating it anteriorly
usually exposes cricopharyngeus.

36. • Scope comes to a dead-stop and pharyngeal lumen disappears as one
reaches cricopharyngeal sphincter
• Ensure that bevel of scope is pointing upward
• Elevate tip of scope against post surface of cricoid with non-dominant
thumb.
• Look for oesophageal lumen to appear while applying steady, firm
pressure against contracted cricopharyngeus.

37. • Slowly advance tip of scope always keeping lumen in view.
• Always consider possibility of pharyngeal pouch (zenker’s
diverticulum).Tightly inflated ET tube cuff may compress esophagus.
• Once esophagoscope has been passed all the way, carefully inspect
for pathology & mucosal trauma while slowly retracting scope.
• Biopsy lesions with long biopsy forceps.

38. • Pathology seen at rigid
oesophagoscopy recorded as its
distance from upper incisors

39. FIBER-OPTIC ESOPHAGOSCOPY
• Fiber-optic esophagoscopy can
be performed under general or
local anesthesia.
• Transnasal or oral
• Topical anesthetic agents are
sprayed into the oral cavity and
oropharynx, a bite guard is
placed, and intravenous
sedation.

40. Technique
• The esophagoscope can be inserted blindly, by feel, through the
esophageal inlet.
• The tip of the endoscope is gently advanced into the hypopharynx to
a distance approximately 18 cm from the incisors upto the level of the
upper esophageal sphincter or muscle.
• The cricopharyngeus is closed at rest and opens during swallowing

42. • The esophageal inlet is visualized, and the endoscope is gently
advanced into the esophagus as the patient swallows.
• Examination is performed to a distance of 40 cm.This is also referred
to as the squamocolumnar mucosal junction or Z line.
• Z line, demarcating the junction between pearly, esophageal,
stratified squamous mucosa and the redder gastric columnar
epithelium.

43. Complications of esophagoscopy
• Injury to lip, teeth & tongue.
• Glottic trauma may involve vocal cord injury or dislocation of
arytenoid cartilages.
• Laryngeal edema.
• Aspiration of gastric contents.
• Cervical spinal cord injury.
• Tachycardia, arrhythmias, hypertension, and myocardial ischemia or
infarction due to sympathetic stimulation.

44. Complications of esophagoscopy
• Mucosal tears/lacerations
• Esophageal perforation
• Mediastinitis.
• Insufflation used during fiber-optic esophagoscopy can cause
abdominal distention, contributing to respiratory compromise

45. •THANK YOU