Aerodigestive & Esophageal Surgery: Dual Endoscopy Discussion

Multiple scopes provide different information and complementary advantages in complicated aerodigestive patients.

Simultaneous dual endoscopy is easier in patients with a tracheostomy, but feasible even without one.

Typical dual-scope setup uses a flexible bronchoscope through the nose and a flexible GI scope through the mouth or retrograde via a gastrostomy tube.

Transillumination allows one operator to see the light from the other scope through the esophageal or airway wall.

Injection of saline or insufflation of air can reveal subtle perforations or fistulae by demonstrating passage of material or bubbles through the wall.

One operator can turn off their light so the other can see transillumination and confirm anatomic localization.

A 2.8 mm flexible bronchoscope is typically used for the airway component of dual endoscopy.

An infant GI scope (5.4 or 6 mm outer diameter) is used for the esophageal component and will fit retrograde through a 16 French gastrostomy tube.

A 14 French gastrostomy tube is too small for retrograde passage of an infant GI scope without dilation.

Intraoperative dilation of a gastrostomy tract with Hagar dilators allows passage of a larger scope; the tract will contract back down by the end of the case.

A bronchoscope can be used retrograde through the esophagus when a larger GI scope will not fit.