Esophagoscopy

Your doctor may wish to examine the lining of your esophagus, the muscular tube that connects the throat to the stomach, for signs of cancer or other illness.

To do this, a scope is inserted through the mouth or nose and down the esophagus. This procedure is called an esophagoscopy. The tool used is called an endoscope, a broad term for a variety of probes that are typically thin, flexible and lighted and often include a means of taking small tissue samples. Esophagoscopy is a type of endoscopy.

Sampling tissue, called a biopsy, helps determine whether a growth is cancerous. If so, doctors may also learn the type and characteristics of the cancer.

• The most common type of esophageal cancer in the United States is adenocarcinoma, which starts in glandular cells in the section of the esophagus near the stomach.
• The most common form of esophageal cancer globally is squamous cell carcinoma, which begins in the flat cells lining the esophagus, usually in the top and middle sections.

An esophagoscopy may be used to investigate other health issues in the head and neck as well, including:

• Stomach acid rising up the esophagus (gastric reflux)
• Difficulty swallowing (dysphagia)
• Persistent feeling of something in the throat (globus)

It may also be used for treatments, such as balloon stretching of the esophagus.

How it’s performed

If your doctor suspects you may have esophageal cancer, an esophagoscopy may be one of the first steps toward diagnosis. It examines the inside surface of the esophagus for abnormalities. During the procedure, a device in the tip of the endoscope may gather cellular material to be examined under a microscope by a pathologist. Tissue may be collected with a needle or forceps. The endoscope may also be used to conduct an ultrasound examination of your esophagus.

A related procedure uses an endoscope to view the esophagus and all of the upper digestive tract, including your stomach and duodenum (the first section of the small intestine). This is called an esophagogastroduodenoscopy (EGD). It’s also termed an upper endoscopy. Your doctor may opt to do an EGD instead of a simple esophagoscopy.

Preparing for your procedure

These procedures differ in the amount of anesthesia and sedation used. If you have an EGD, a local anesthetic may be sprayed in your mouth to reduce gagging or coughing caused by the scope, and you’ll be given a sedative to relax you and make you less conscious of discomfort. The sedative may be given through an intravenous (IV) line. Sedation and general anesthesia (which often uses inhaled gases) aren’t necessary for a transnasal esophagoscopy. Some endoscopic procedures may be done in your doctor’s office; others take place in a hospital setting. For an esophagoscopy, you may be given a mouth guard to protect your teeth during the procedure.

Whether to use sedation and how much depends on both the technique used and your preferences. Under moderate sedation, you may be drowsy but still follow your care team’s instructions. Deep sedation may approach or be equivalent to general anesthesia—you’re unconscious. If sedation is required, your doctor may advise you not to eat or drink for a period of time before the procedure, usually at least eight hours.

As you would before any outpatient procedure:

• Discuss with your care team what to expect and any concerns or questions.
• Inform your doctor of your medical history, including allergies and chronic conditions, as well as any medications (prescription and over-the-counter), vitamins, supplements and herbal preparations you take.
• Ask whether you need to avoid blood-thinning drugs, aspirin and herbal supplements for several days before the procedure.

If you’re going to be sedated or placed under general anesthesia, you may need to arrange for someone to take you home afterward.

You may be sent home after the procedure with instructions about any activities to avoid and symptoms of problems you should report to your care team.

Risks

Serious complications are rare but possible after an endoscopy. Risks include:

• Perforation or tear of the esophagus
• Bleeding
• Infection
• Dental damage
• Irritation in the nose or throat
• Side effects from sedation, such as trouble breathing or feeling ill

Call your doctor immediately if you:

• Feel feverish or have a high temperature
• Have black stools
• Vomit blood
• Experience chest pain
• Have a hard time swallowing