Aerodigestive & Esophageal Surgery: Dual Endoscopy Discussion
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- Dual endoscopy allows visualization of light transmission through tissue walls, revealing subtle fistulas or anatomical relationships
- Simultaneous scopes (2.8mm bronchoscope + 5.4-6mm infant GI scope) can fit even in small infants, easier with tracheostomy present
- Retrograde esophagoscopy through G-tube (≥16Fr) enables injection testing and bubble visualization to identify occult perforations
- Coordinated light on/off between operators helps confirm anatomical location and spatial relationships during complex cases
- Intraoperative dilation of G-tube from 14Fr to 16Fr allows passage of infant endoscope for combined procedures
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enormously valuable to have scopes for these complicated patients to have multiple scopes in because they give you different information and they have different. Advantages in terms of what you can see and what you can't see, and to combine them, it has been, I've been very impressed since I've been here at how enormously helpful that is on many occasions. Can I ask about that technically? So I usually go in and I just keep going back and forth. I've never done simultaneous. Is it, it's pretty easy to fit two scopes down at the same time in these little. Babies, um, it's obviously it's easier if they have a tracheotomy, but even without a tracheotomy we can cram it all in. OK. And so usually typically Bob's using a flex scope through the nose. Phil's got a flexible scope through the mouth or the through the G tube you can go retrograde in the esophagus, OK, but you can see. The light from the other scope through the epithelium through the wall, you can inject material that may come through a hole that's otherwise subtle, even saline you can see coming through or bubbles if there's insufflation of air from the endoscope. So it's really quite valuable to do it simultaneously. That's great. That's a great trick I've ever tried, and you can occasionally get one of the two people to turn off their light so that. That person can then see your light and flip backwards and forwards and try and see just are you in the right region. There's a question about, uh, uh, there's a question from the audience. What size scope are we talking about here? So you said you'll use a, I typically use a 2.8 millimeter flexible scope, bronchoscope, and then the, the GI scope for a combined purpose in a small child is almost always an infant scope, which is either 5.4 or 6 millimeters and. Outer diameter, which will fit retrograde through a 16 French gastrostomy tube and an infant scope will fit through the mouth and just about anything. Phil always chips at me when I put in a 14 French G tube because it's not big enough to get to dilate. I mean, and we actually, I mean, we have Hagar's in the room. We dilate it up, you put it in. By the end of the case, it'll come right back down. So it's not occasion we'll use a bronchoscope for a retrograde esophagus. That's, yeah, because you can fit it in. It works nicely, yeah. So we're going to move on to case 2.