Aero-digestive Endoscopy Dr. Vishal Sharma

History

Bozzini (1806): angled speculum with mirror using wax candle, first examined larynx Manuel Garcia (1854): Using dental mirror, hand mirror & sunlight visualized his own vocal cords Adolph Kussmaul (1868): 1 st rigid esophagoscopy Gustav Killian (1897): 1 st rigid bronchoscopy Chevalier Jackson (early 1900s): father of modern rigid endoscopy Oscar Kleinsasser (1960): suspension micro-laryngoscope Shigeto Ikeda (1966): first fiberoptic bronchoscopy & oesophagoscopy H.H. Hopkins: rigid fiberoptic telescopes

Adolph Kussmaul

Gustav Killian

Chevalier Jackson

Shigeto Ikeda

Direct Laryngoscopy

Chevalier Jackson’s Direct Laryngoscope

Anterior commissure Direct Laryngoscope

Boyce’s Endoscopy position Supine position with head elevated by 10 cm

Tongue Base visualized

Epiglottis visualized

Vocal cords visualized

Micro-laryngoscopy

Kleinsasser Microlaryngoscope

Chest Piece

Laryngoscope fixed

Microscope focused

Indications for Laryngoscopy

Diagnostic Therapeutic  Biopsy of suspected malignancy  Foreign body in larynx & pyriform fossa removal (larynx & pyriform fossa)  Examination of hidden areas:  Excision biopsy anterior commissure, laryngeal of benign ventricle, subglottis, infrahyoid laryngeal lesion epiglottis, pyriform fossa apex  Dilatation of laryngeal stricture  Unsuccessful indirect laryngoscopy

Micro-laryngoscopyDirect Laryngoscopy Binocular visionMonocular vision Better illuminationLess illumination MagnificationNo magnification Better precisionLess precision Both hands are free1 hand holds scope Video attachment possibleNo Can be combined with microscopic Laser No

Rigid Bronchoscopy

Rigid Bronchoscope

Close-up of proximal end

Bronchoscope introduced

At laryngeal inlet

Epiglottis identified

Vocal cords identified

Scope passed through glottis after 90 0 rotation

Scope rotated back

Tracheal rings identified

Carina identified

Bronchopulmonary segments

Endoscopy position

Scope in Right bronchus

Scope in Left bronchus

Flexible Bronchoscope

Indications for Bronchoscopy 1.Broncho-alveolar lavage for C/S, AFB, cytology 2.Biopsy of tracheo-bronchial tumours 3.Investigation of chronic cough, hemoptysis, Lt vocal cord palsy, atelectasis, obstructive emphysema, mediastinal growths 4.Removal tracheo-bronchial of foreign bodies 5.Removal of retained respiratory secretions

Rigid BronchoscopyFlexible Also functions as airwayNo Better for removal of foreign bodyNo Allows use of LaserNo Visualizes up to 3 rd bronchial division5 th division Not done under local anesthesiaDone Not done in cervical spine problemsDone More risky & traumaticSafer Not done for trans-bronchoscopic biopsyDone

Rigid Oesophagoscopy

Rigid Oesophagoscope

Jackson scopeNegus scope Distal illuminationProximal illumination No markingsMarked NarrowBroad Constant diameterTapered Single bulbDouble bulb

Epiglottis visualized

Right pyriform fossa

Cricopharyngeal sphincter

Upper Oesophagus

Middle Oesophagus

Lower Oesophagus

Indications for Oesophagoscopy 1. Investigation of dysphagia, haematemesis, GERD, neck node metastasis of unknown origin 2. Oesophageal foreign body removal 3. Excision biopsy of benign oesophageal lesions 4. Dilatation of oesophageal strictures 5. Sclerotherapy for oesophageal varices 6. Insertion of palliative oesophageal feeding tube

Rigid OesophagoscopyFlexible Better for cricopharynx examinationNo Better for removal of foreign bodyNo Allows use of LaserNo Not good for lower oesophageal examnGood Not done under local anesthesiaDone Not done in cervical spine problemsDone More risky & traumaticSafer

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