Passage through the Upper Esophageal Sphincter

Unless the patient swallows, it is extremely difficult to advance the endoscope through the upper esophageal sphincter without causing injury or significant discomfort. Endoscope insertion is contraindicated while the patient is coughing or taking a deep breath, as this will inevitably lead to tracheal intubation (Fig. 2.2). The period immediately after coughing, when the patient is swallowing saliva, is a favorable time for entering the esophagus. At this time the larynx is in an elevated position, visible externally on the neck. The endoscope is advanced by applying gentle pressure. Following initial resistance, a distinct "give" is felt as the endoscope slips into the upper esophagus. Once the instrument tip is within the esophagus, the insertion is continued under endoscopic vision.

Fig. 2.3 Larynx and pharynx a Anteroposterior (AP) radiograph after oral contrast administration. The piriform recess descends lateral to the larynx. Medial to it is the intro-itus of the upper esophageal sphincter b Lateral radiograph after oral contrast administration. The piriform recess appears as an outpouching structure lateral and anterior to the upper esophageal sphincter

Piriform Recess

Tip retroflexed in the nasopharynx

Tumors

Deviation into the piriform recess

Cervical spondylosis Intubation of the trachea Zenker diverticulum

Fig. 2.2 Risks and hazards of endoscope insertion

Tip retroflexed in the nasopharynx

Tumors

Deviation into the piriform recess

Cervical spondylosis Intubation of the trachea Zenker diverticulum

Fig. 2.2 Risks and hazards of endoscope insertion

Piriform RecessContrast Piriform Recess

Fig. 2.3 Larynx and pharynx a Anteroposterior (AP) radiograph after oral contrast administration. The piriform recess descends lateral to the larynx. Medial to it is the intro-itus of the upper esophageal sphincter b Lateral radiograph after oral contrast administration. The piriform recess appears as an outpouching structure lateral and anterior to the upper esophageal sphincter

Upper esophageal sphincter

Esophagus

Trachea

Upper esophageal sphincter

Esophagus

Trachea

Was this article helpful?

0 0

Responses

  • dieter
    How does the larynx appear on radiographs?
    3 years ago

Post a comment