Direct laryngoscopy, bronchoscopy and oesophagoscopy
- Procedure
With rigid or flexible tubes and anaesthesia, the larynx, trachea, bronchi and oesophagus are inspected from inside to biopsy or remove objects.
See it in 3D: Epiglottis · Vocal folds · Trachea · Main bronchi · Esophagus · Pharynx
What it is
Endoscopy of the upper aerodigestive tract includes direct laryngoscopy (with a rigid laryngoscope and often a microscope: microlaryngoscopy), bronchoscopy (rigid or flexible) and oesophagoscopy (rigid or flexible). The rigid version is done in theatre under general anaesthesia and is the choice for removing foreign bodies and for the paediatric airway; the flexible version is often done under sedation. Panendoscopy combines all three to stage a head and neck cancer and look for a second primary tumour. This page is an educational overview, not a guide to performing the procedure.
Indications and contraindications
- Direct laryngoscopy: biopsy of laryngeal and hypopharyngeal lesions, vocal fold surgery (nodules, polyps, papillomas), assessment of stridor in children.
- Bronchoscopy: foreign body, haemoptysis, persistent atelectasis, biopsy of a bronchial tumour, bronchoalveolar lavage, suction of secretions.
- Oesophagoscopy: foreign body (coin, button battery, food bolus), dysphagia, suspected cancer, stricture dilatation, varices.
- Panendoscopy: staging of head and neck cancer and search for the primary in a cervical metastasis of unknown origin.
- Contraindications: cervical spine instability, trismus, severe kyphosis, aortic aneurysm (rigid oesophagoscopy), unstable patient without a secured airway.
- Caution: coagulopathy, loose teeth, uncontrolled hypertension and recent caustic stricture.
How it is done
- Before: airway history, imaging (neck and chest X-ray, CT), fasting and an airway plan shared with anaesthesia.
- The upper teeth are protected and the patient is placed in the sniffing position.
- Direct laryngoscopy: the rigid laryngoscope advances over the tongue base and vallecula to expose the glottis; a microscope is used for fine surgery.
- Rigid bronchoscopy: the bronchoscope is passed between the cords rotated and ventilation goes through its side port; trachea, carina and bronchi are inspected.
- Rigid oesophagoscopy: passed gently through the cricopharyngeus under direct vision, without force.
- Biopsies are taken or the foreign body is removed with suitable forceps; a button battery is removed as an emergency.
- After: observation of breathing and voice; diet restarted carefully after oesophagoscopy.
Rigid compared with flexible endoscopy
| Feature | Rigid | Flexible |
|---|---|---|
| Anaesthesia | General, in theatre | Local or sedation, in clinic or endoscopy suite |
| Advantage | Wide channel, good ventilation, bleeding control | Reaches distal bronchi and stomach; better tolerated |
| Preferred use | Foreign bodies, paediatric airway, massive haemoptysis, obstructing tumours | Diagnosis, bronchoalveolar lavage, biopsies, follow-up |
| Limitations | Needs a mobile neck and a mouth that opens | Small channel; of little use with heavy bleeding |
Complications
- Oesophageal perforation (cervical or thoracic): pain, fever, subcutaneous emphysema and mediastinitis.
- Injury to teeth, lips, tongue and pharynx.
- Laryngeal or subglottic oedema with stridor after extubation, more often in children.
- Laryngospasm, bronchospasm and hypoxia during bronchoscopy.
- Pneumothorax and bleeding after bronchial biopsies.
- Cervical spine injury if instability is not recognised.
Next step / Initial management
- For a suspected foreign body: neck and chest X-ray (front and lateral); a button battery shows a double-ring outline and is an emergency.
- Keep the patient fasting and in a comfortable position; do not attempt blind removal or induce vomiting; give oxygen if there is breathing difficulty.
- Refer as an emergency, immediately, to ENT or paediatric pulmonology every child with a suspected airway foreign body or an oesophageal button battery.
- After oesophagoscopy: if chest or neck pain increases, or there is fever, subcutaneous emphysema or painful swallowing, refer urgently the same day (suspected perforation).
- Refer with priority to ENT for panendoscopy hoarseness or dysphagia lasting more than 3 weeks in a smoker or drinker, or a persistent neck lump.
Test yourself
Think of the answer, then tap the question to see it.
A 2-year-old has sudden cough while eating peanuts and one-sided wheeze. Which procedure confirms and treats?
Rigid bronchoscopy under general anaesthesia: it allows ventilation, inspection and removal of the foreign body.
Where is perforation most common during rigid oesophagoscopy?
At the oesophageal inlet, at the level of the cricopharyngeus muscle, the narrowest part with a weak posterior wall.
Why is panendoscopy done in a patient with newly diagnosed laryngeal cancer?
To biopsy and map the tumour's extent and to look for a synchronous second primary tumour in the upper aerodigestive tract.
What contraindicates rigid oesophagoscopy?
An unstable or rigid cervical spine, trismus, severe kyphosis and aortic aneurysm; in these cases the flexible route is used.
Elsewhere in DurgiPedia
Connections
See it in 3D6
The structures of Durgical's 3D anatomy where it is found.
Educational content; it does not replace a medical assessment and is not a clinical instruction. For a real case, follow current guidelines and specialist advice.
Sources: Direct Laryngoscopy (StatPearls) (StatPearls Publishing, NCBI Bookshelf, 2023); Bronchoscopy (StatPearls) (StatPearls Publishing, NCBI Bookshelf, 2026); Esophagogastroduodenoscopy (EGD) (StatPearls) (StatPearls Publishing, NCBI Bookshelf, 2026); Laryngoscopy and nasolaryngoscopy (MedlinePlus, U.S. National Library of Medicine, 2025).
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Representative model, for educational purposes only.