Problems

In both methods—blind and direct-vision insertion—there is always a short segment of the esophagus that must be traversed without vision.

If a Zenker diverticulum is present in this region, there is a substantial risk of perforation.

If the endoscope is misdirected toward the trachea, the vocal cords (Fig. 2.5 a) or the typical ribbed walls of the trachea (Fig. 2.5 b) will be seen. In this case the endoscope should be withdrawn at once.

ga = glottic aperture e = epiglottis pr = piriform recess ues = upper esophageal sphincter sc = spinal column

Fig. 2.4 View of the trachea and upper esophageal sphincter. Notice that the slitlike upper esophageal sphincter, not yet visible in the upper plane, lies between the interarytenoid incisure and the spinal column. The epiglottis, which extends to a relatively high level, is usually difficult to identify. The lower plane is at the level of the upper esophageal sphincter ga = glottic aperture e = epiglottis pr = piriform recess ues = upper esophageal sphincter sc = spinal column

Fig. 2.5 Misdirected intubation a Impending tracheal intubation. View of the vocal cords

Fig. 2.5 Misdirected intubation a Impending tracheal intubation. View of the vocal cords

b The typical ridged contours of the trachea can be seen

Fig. 2.4 View of the trachea and upper esophageal sphincter. Notice that the slitlike upper esophageal sphincter, not yet visible in the upper plane, lies between the interarytenoid incisure and the spinal column. The epiglottis, which extends to a relatively high level, is usually difficult to identify. The lower plane is at the level of the upper esophageal sphincter b The typical ridged contours of the trachea can be seen

Fig. 2.6 Intubation of the esophagus

a The instrument tip is over the base of the b The instrument has been advanced. View tongue. The upper border of the epiglottis is into the hypopharynx visible

c The instrument has been advanced further. The esophageal inlet is visible at the 6-o'clock position

d The instrument tip is positioned between the posterior wall of the hypopharynx and the posterior wall of the larynx. When the patient swallows, the upper esophageal sphincter can be seen

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