Introduction of the oesophagoscope is done into three stage

• Passage through the cricopharyngeal sphincter, called the ‘pinch cock’.
• Passage through the thoracic oesophagus.
• Passage through the hiatal sphincter.
• The proximal part of the oesophagoscope is held like a pencil in the right hand.
• The oesophagoscope is passed up-to the base of the tongue, the epiglottis, arytenoids and endotracheal tube is identified. The tip of the oesophagoscope is passed behind the right posterolateral pharyngeal wall and into the right pyriform sinus.
• The cricopharyngeus muscle at the sphincter remains in a state of contraction. The distal position of the oesophagoscope is lifted anteriorly by the left thumb with slow sustained pressure, the oesophagus opened. The danger of oesophageal perforation at this point is very high. No force should be used.
• After the sphincter is opened, the oesophagoscope is passed easily into the thoracic oesophagus.
• Head of the patient slightly lowered. The narrowing of the oesophagus at the crossing of the aortic arch and left bronchus lies about 25 cms from the incisors. The aortic pulsations are seen.

• 9. The head and shoulders are lowered below the level of the table, head being slightly higher than the shoulders and moved slightly to the right. At this stage, the oesophagoscope points to the left anterior-superior iliac spine. The hiatal opening presents as a small slit from 10 o’clock to 4 o’clock position.
• 10. The cardiac end is identified by its reddish mucosa.
• 11. The oesophagoscope is always removed under direct vision.

Complications:

• Damage to the lips and teeth.
• Perforation of oesophagus or pharynx: It is the most serious complication. Patient needs to be monitored regularly for development of surgical emphysema within the neck, severe pain, breathlessness and intra-abdominal pain.
• Perforation of the lower end may result in a clinical picture of an acute abdominal emergency.
• Hematoma of posterior pharyngeal wall.
• Failure to obtain appropriate biopsy.