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Esophagus research methods

Along with the well-known subjective methods of research (clarification of the circumstances of the development of a pathological condition, analysis of complaints, etc.), in the study of the esophagus, the most significant are two methods of objective research: radiation (radiological) and esophagoscopic.

The main indication for the study of the esophagus is a violation of its function - i.e. certain violations of patency. The latter can be caused by foreign bodies, tumors, burns, strictures, diverticulums, infectious granulomas, various neurogenic disorders that cause dysphagia.

Beam research. Among radiation research methods, the X-ray method is the main and most common non-invasive diagnostic method for various diseases of the esophagus, which allows to obtain valuable objective data for organic and functional disorders. This study should precede any other instrumental methods. There is a known sequence of x-ray examination of the esophagus. First, a fluoroscopy (graph) of the neck and chest area is performed in the straight, lateral and, if necessary, in oblique projections without the use of a contrast medium, to obtain the initial x-ray picture.

The use of contrast agents makes it possible to determine the condition of the walls of the esophagus, the relief of the mucous membrane, and increase the contrast of a suspicious formation. There are practically no contraindications to contrast x-ray examination. If you suspect a violation of the integrity of the wall of the esophagus, it is recommended to use water-soluble contrast agents.

Diagnostic capabilities of radiation examination of the esophagus are expanded by more sophisticated methods: linear, computed (CT) and magnetic resonance (MRI) imaging, as well as for special studies - X-ray cinematography, X-ray television cinematography, etc. Radiation and, above all, X-ray examination, with good reason considered the main method of studying the function and diagnosis of diseases of the esophagus. In the process of considering individual diseases of the esophagus, specific techniques and examples of radiation research will be presented.

Esophagoscopic examination. Esophagoscopic research method combines diagnostic and therapeutic options. It allows you to visually assess the condition of the esophagus wall, identify the presence of various pathological formations, perform a biopsy and some surgical procedures, as well as remove foreign bodies. At the same time, esophagoscopy, although it is a very valuable method of research and treatment, is a very dangerous manipulation that can cause instrumental damage to the wall of the esophagus, which can lead to the development of mediastinitis with a possible fatal outcome. Therefore, esophagoscopy should be performed according to strict indications and by a person who owns the technique of instrumental examination of the esophagus.

Given the possibility of damage to the esophagus wall during diagnostic esophagoscopy, performed with suspected foreign body and a significant percentage of esophagoscopy done "in vain", during which the foreign body was not detected, K.L. Khilov recommends performing esophagoscopy not for the diagnosis of a foreign body of the esophagus, but essentially only for its removal. Diagnosis of foreign bodies of the esophagus should be based on knowledge of the physiological characteristics of the esophagus, the clinical picture, assessment of subjective and objective research methods and data obtained by x-ray, or other method of radiation research.

Currently, two classes of instruments can be used for esophagoscopy: a rigid (rigid) esophagoscope and a flexible fibroendoscope.

A rigid esophagoscope is a device consisting of a illuminator mounted in a handle and a set of endoscopic tubes of various diameters, some of which are insertion tubes to increase the total length of the endoscope, when examining the deep sections of the esophagus.
In our country, over the years, rigid esophagoscopes (broncho-esophagoscopes) designed by Brunings and Mezrin have been successfully used. Various assistive devices are attached to the esophagoscope, as well as a set of tools necessary for biopsy and removal of foreign bodies from various depths of the organ under investigation (Fig. 5.4).

The advantage of a rigid instrument is the convenience of removing foreign bodies and conducting a biopsy. At the same time, they have serious drawbacks determined by the design itself - a rigid metal tube, the introduction of which under local anesthesia is quite painful for the subject and can easily cause damage to the esophagus wall. In the presence of spinal deformity (scoliosis) and a number of other diseases, the introduction of an endoscopic tube becomes problematic and dangerous.

To a large extent, these flaws are deprived of a flexible fibroesophagogastroscope (Fig. 5.5), equipped with fiberglass optics, which makes it possible to examine the object under study in detail under magnification. Using the channel available in the fiberscope, it is possible not only to aspirate the contents of the esophagus, but also locally bring the drug substance. The fiberscope allows you to biopsy and remove small foreign bodies. With the help of special optical nozzles - adapters, photo and film shooting can be made, which allows documenting a clinical case for educational, scientific and other purposes (Savelyev BC et al., 1977; Iskhaki Yu.B., 1994; Ovchinnikov Yu.M., 1995).

At the same time, a flexible fibroscope is inferior to a rigid esophagoscope in the ability to remove large and sharp foreign bodies. Therefore, at present, the main method of removal of foreign bodies of the esophagus continues to be esophagoscopy, performed by a direct rigid esophagoscope under general anesthesia with the use of muscle relaxants. A rigid esophagoscope allows you to remove foreign bodies of almost any size, including wedged into the wall of the esophagus and, often very insidious, food (meat) blockages. Removing metal foreign bodies - dentures, pins with sharp ends protruding upwards, or similar objects requires a virtuoso technique related to the rotation of an acute, often foreign body wedged into the esophagus wall, introducing its ends into the lumen of the esophagoscope tube for subsequent removal (Fig. 5.6 and 5.7). All this, we repeat once again, can only be done using a rigid esophagoscope.

Esophagoscopy is usually performed on an empty stomach. Otherwise, regurgitation is possible with the stomach contents being thrown into the airways, fraught with the danger of an attack of bronchospasm and the development of pneumonia.

Absolute contraindications to esophagoscopy are acute inflammatory diseases of the esophagus, severe aortic aneurysm and hemophilia. Relative - severe heart and lung disease, high grade hypertension, pronounced spinal deformity, stenosis of the larynx and trachea, severe goiter, the first days after an esophageal burn (Iskhaki Yu.B., 1994).
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Esophagus research methods

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