F Esophagoscopy and gastroscopy

Flexible, diagnostic esophagogastroduodenoscopy, a common procedure in pediatrics, is usually performed with the patient under deep sedation in an endoscopy suite or special procedure area. Rigid esophagoscopy is usually performed for therapeutic indications, such as removal of a foreign body, dilation of an esophageal stricture, or injection of varices. The procedure is similar for each diagnosis and is generally performed with endotracheal intubation. Foreign body removal is normally a short procedure, but dilation and variceal injection can be prolonged and may require multiple insertions or removals of the endoscope. Compression of the trachea distal to the endotracheal tube by the rigid esophagoscope is common.

Esophagoscopy for foreign body removal is usually performed in healthy infants and children, although esophageal lodging of a foreign body can occur in any age group. All of these patients should be treated with full-stomach precautions. Esophageal dilation usually is performed in two distinct patient populations: those with prior tracheoesophageal fistula repair and those with prior ingestion of a caustic substance.

a) History and physical examination

(1) Cardiovascular: Patients with tracheoesophageal fistulas may have congenital cardiac anomalies.

(2) Respiratory: Patients with prior caustic ingestion may have a history of pulmonary aspiration, with resultant chemical pneumonitis, fibrosis, or both. Prolonged intubation after tracheoesophageal fistula repair may lead to subglottic stenosis. Check any recent anesthesia records for endotracheal intubation.

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