Gastroscopy Exploration Under Local Anesthesia

All patients were deprived of food and water (≧6 h) and did not receive sedative measures before gastroscopy. Local anesthesia was conducted with 10 ml oral lidocaine gel 20 min prior to examination. An electronic fiberoptic endoscope with a diameter of 0.52 or 0.92 cm was selected according to the children's age, height, and weight. The left lateral decubitus position was assumed for the examination. After a dental pad was placed, the doctor manipulated the endoscope into the oral cavity until the esophageal entrance. Then, the pyriform sinus and Betz folds were fully exposed. The pyriform sinus on the affected side was first explored; subsequently, repeated ventilation and irrigation with sterile water were utilized (the extension of local folds as the standard) to search for the internal opening of CPSF (Figure 1A). Then, the same strategy was performed in the contralateral pyriform sinus. In addition, the examination would be stopped and patients would receive symptomatic treatment immediately if they suffered severe cough, mucosal bleeding, and unstable vital signs. In retrospect of our study, none of the patients we recruited dropped out, and only three had minor bleeding in the mucosa of laryngopharyngeal after the examination intervention. Gastroscopy was performed by one gastroenterologist, and the presence of the internal fistula opening was confirmed by two physicians (one gastroenterologist and one otolaryngologist). Disagreements were resolved by consensus with another experienced physician. In this study, only one case was finally resolved by another experienced physician, in which it was difficult to determine the internal opening as the surrounding adhered tissue blocking the fistula.

(A) Left internal opening of CPSF and Betz folds using gastroscopy under local anesthesia. (B) Left internal opening of CPSF, Betz folds, and esophageal entrance using support laryngoscopy under general anesthesia. The arrow indicates the internal opening of CPSF.