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): 1st rigid esophagoscopy

Gustav Killian (1897): 1st 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-laryngoscopy Direct Laryngoscopy

Binocular vision Monocular vision

Better illumination Less illumination

Magnification No magnification

Better precision Less precision

Both hands are free 1 hand holds scope

Video attachment possible No

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 900 rotation

Scope rotated back

Tracheal rings identified

Carina identified

Bronchopulmonary segments

Endoscopy position

Scope in Right bronchus

Scope in Right bronchus

Scope in Right bronchus

Scope in Left bronchus

Scope in Left 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 Bronchoscopy Flexible

Also functions as airway No

Better for removal of foreign body No

Allows use of Laser No

Visualizes up to 3rd bronchial division 5th division

Not done under local anesthesia Done

Not done in cervical spine problems Done

More risky & traumatic Safer

Not done for trans-bronchoscopic biopsy Done

Rigid Oesophagoscopy

Rigid Oesophagoscope

Jackson scope Negus scope

Distal illumination Proximal illumination

No markings Marked

Narrow Broad

Constant diameter Tapered

Single bulb Double 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 Oesophagoscopy Flexible

Better for cricopharynx examination No

Better for removal of foreign body No

Allows use of Laser No

Not good for lower oesophageal examn Good

Not done under local anesthesia Done

Not done in cervical spine problems Done

More risky & traumatic Safer

Thank You