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PubMed2006

Transnasal esophagoscopy.

PURPOSE OF REVIEW: Transnasal esophagoscopy is the most significant new development in laryngology/bronchoesophagology in recent years. This paper is designed to review the most important articles involving transnasal esophagoscopy over the past year. RECENT FINDINGS: Transnasal esophagoscopy is safe, effective, easy to learn, and significantly alters the management of a large number of individuals seen in otolaryngology practice. SUMMARY: Transnasal esophagoscopy has a major role in otolaryngology and gastroenterology practice and will enable the endoscopist to provide better quality of care to patients in a more cost-effective and safer manner.

Esophageal Diseases↗

PubMed2003

A prospective, blinded study of diagnostic esophagoscopy with a superthin, stand-alone, battery-powered esophagoscope.

OBJECTIVES: A more widely available, well-tolerated, and cost-effective technique is needed to screen a broad population at risk for esophageal cancer. An ideal solution might be to perform unsedated esophagoscopy with an entirely self-contained, small-caliber endoscope. In a prospective, blinded study in three phases, we compared the feasibility, patient tolerance, and diagnostic accuracy of esophagoscopy performed with a prototype, superthin, battery-powered esophagoscope (BPE) with standard video esophagogastroduodenoscopy (SVE). METHODS: In phase I, 10 healthy volunteers underwent both peroral and transnasal esophagoscopy with BPE to evaluate the technical feasibility of the examination. For phases II and III, patients were recruited to have BPE before SVE. In phase II, both procedures were performed with conscious sedation. In phase III, the BPE was performed with only topical anesthesia. Two endoscopists assessed the technical performance of the endoscope and patient tolerance and recorded the esophageal findings independently. RESULTS: In phase I, all endoscopists reported adequate visualization of the esophagus in the 10 volunteers. A total of 181 patients were evaluated in phases II and III (89 in phase II, 92 in phase III). The sensitivity for detecting columnar lined esophagus was 94% in phase II and 95% in phase III. The sensitivity for all esophageal findings was 87% and 86% in phases II and III, respectively. The technical performance of the endoscope was significantly worse for BPE compared with the SVE. The patient tolerance as evaluated by the endoscopist was similar for both procedures. Ninety-five percent of the patients undergoing unsedated BPE were willing to have the procedure repeated under similar circumstances. CONCLUSIONS: Unsedated esophagoscopy with a 3.1-mm, battery-powered, stand-alone esophagoscope is feasible, well tolerated, and accurate in detecting esophageal pathologies. It might be an efficient and cost-effective screening tool for the detection of columnar lined esophagus.

Adult↗

PubMed1987

The diagnostic accuracy of pharyngoesophagram compared to esophagoscopy in patients with head and neck cancer.

Two hundred and fifty-four patients with head and neck cancer were entered into a prospective study comparing the results of pharyngoesophagram to esophagoscopy. All patients had pharyngoesophagram deemed adequate to evaluate the esophagus and rigid esophagoscopy to at least 30 cm from the upper incisor teeth. In 239 (94.1%) patients both the pharyngoesophagram and esophagoscopy were negative. Four esophageal tumors were found. Only one of these tumors (25%) was detected on pharyngoesophagram. We believe that the pharyngoesophagram should be a part of the initial work-up of every head and neck cancer patient and should precede esophagoscopy. However, the barium swallow cannot be relied upon exclusively to detect small simultaneous second primary esophageal malignancies.

Aged↗

PubMed2001

Flexible esophagoscopy as part of routine panendoscopy in ENT resident and fellowship training.

We conducted a retrospective study to evaluate the use of flexible esophagoscopy as part of routine panendoscopy in an academic setting. We reviewed the results of 378 procedures that were performed over a 4-year period in an academic otolaryngology--head and neck surgery program for residents and fellows. Medical records were reviewed for early and late complications as well as for adequacy of the examination. We found no immediate or long-term complications associated with flexible esophagoscopy. Adequate examination was achieved in all but two cases (99%), both of which involved patients who had significant strictures related to radiation therapy and who were not able to be evaluated by rigid esophagoscopy. We conclude that flexible esophagoscopy is a safe and accurate means of evaluating the esophagus during a panendoscopic evaluation of the upper aerodigestive tract, and that it should be included in the diagnostic armamentarium of every otolaryngology--head and neck surgery resident and fellow.

Diagnosis, Differential↗

PubMed2003

[Esophagoscopy in adults. Our experience and review of the literature].

We are reporting our 12 years-experience about the extraction, by rigid esophagoscopy, of esophageal foreign bodies in adults. Between 1990 and 2002 we have performed 62 esophagoscopies under general anesthesia corresponding 39 to women and 23 to men with 68 years-old average. A series of variables have been studied: personal history, clinical symptoms, type of foreign body and evolutive period. Besides, we have analysed the esophageal location and complications of the surgery such as ulcerations and perforations. The number of procedures have decreased to a great extent because of flexible endoscopy which is the first choice technique. Actually only less than 15% of all emergencies for that pathology require a rigid esophagoscopy in our Hospital.

Adolescent↗

PubMed2003

Esophagoscopy for removal of foreign bodies in the pediatric population.

A retrospective chart review of children who had rigid esophagoscopy for potential foreign body ingestion from 1998 to 2001 was conducted at Children's Hospital of Michigan Detroit. All pediatric patients less than 11 years of age who presented with suspected foreign body ingestion in a hospital setting over a 4-year period were retrospectively studied. Patient characteristics noted included age, sex and clinical presentation. Pre-operative radiographic findings, esophagoscopy findings, clinical presentations and types of foreign bodies were recorded. A history compatible with foreign body ingestion dictates diagnostic endoscopy with or without radiographic confirmation, and an acceptable rate of performing esophagoscopy without finding a foreign body was found to be 6.2%.

Airway Obstruction↗

PubMed2003

Benign esophageal tumors: esophagoscopy and endoscopic esophageal ultrasound.

Benign esophageal tumors are uncommon. Flexible fiberoptic esophagoscopy (esophagoscopy) has improved detection but is ineffective in classification of extramucosal tumors. Endoscopic esophageal ultrasound (EUS) is vital in diagnosis. Small lesions that have either a homogeneous anechoic, intermediate, or hyperechoic pattern are almost exclusively benign. These findings, plus the determination of the layer of origin within the esophageal wall, permit precise and accurate noninvasive diagnosis. The diagnosis of a benign esophageal tumor by esophagoscopy and EUS in an asymptomatic patient requires, at most, surveillance but no therapy.

Endosonography↗

PubMed1997

Predictive value of early postoperative esophagoscopy for occurrence of benign stenosis after cervical esophagogastrostomy.

BACKGROUND AND STUDY AIMS: Benign anastomotic stenosis (BAS) represents a frequent complication following esophagectomy and cervical esophagogastrostomy for cancer. This study was undertaken to evaluate through early postoperative esophagoscopy the morphologic change of the anastomosis which could be related to BAS development. PATIENTS AND METHODS: Thirty-nine patients who underwent subtotal esophagectomy and cervical esophagogastrostomy were prospectively evaluated. The analyzed factors were: age; sex; the anastomotic size; the presence and number of endoscopically visible stitches; the presence and percentage of mucosal ulcerations involving the anastomotic suture line; the presence of anastomotic leak or dehiscence; the vascularization of the gastric tube; the patency of pylorus. RESULTS: No complications related to the early esophagoscopy were observed. Twelve patients (30.7 %) developed a stenosis postoperatively. The univariate analysis demonstrated anastomotic leak (p < 0.006), more than one endoscopically visible stitch (p < 0.0003), and mucosal ulceration involving more than 50% of the anastomosis (p<0.00009) as factors significantly correlated with BAS development. However stepwise logistic regression extracted the presence of ulcerations involving more than 50% of the anastomosis as the most important independent factor in predicting BAS development (Odds Ratio = 9.03+/-5.5, p = 0.009). All patients who developed a BAS were treated with early pneumatic dilatations, with an 83.3% success rate after a mean of 3.6 sessions. CONCLUSIONS: Early postoperative esophagoscopy seems a safe and effective tool for the monitoring of the anastomosis healing after cervical esophagogastrostomy. The presence of extended mucosal ulcerations appeared as the most important factor in predicting BAS formation.

Anastomosis, Surgical↗

PubMed1997

[The current status of broncho-esophagoscopy in otorhinolaryngology].

Most bronchoscopies and esophagoscopies are currently performed with flexible instruments by the respective specialist. Thus the field of bronchoesophagology is in danger of being fragmented; neither the pneumologist nor the gastroenterologist have the complete overview of the upper respiratory and digestive tract. This review shows that number of pathologic conditions in the ENT area and the mediastinum involve the upper respiratory as well as the digestive tract, and thus underscore the need for combined tracheobronchial and esophageal endoscopy. Mastering of rigid and flexible endoscopy is mandatory to be efficient in diagnostic and therapeutic broncho-esophagoscopy. The ENT specialist is in the best position to maintain an overview of this whole field. New developments in broncho-esophagoscopy are presented and discussed in terms of cost effectiveness.

Anesthesia↗

PubMedDate not supplied

Role of esophagoscopy in the evaluation of patients with head and neck carcinoma.

A retrospective study was conducted of 696 patients with squamous cell carcinoma of the head and neck seen over a 10-year period. Special focus was placed on secondary esophageal primaries in this group in an effort to define the role of esophagoscopy in the management of these patients. Second primary esophageal lesions were infrequently encountered (17 of 696, or 2.4% of the patients). Diagnostic accuracy of the esophagogram in a series of patients with index head and neck tumors and in a separate series of patients with index esophageal lesions was found to be high (98 + %). Based upon this study, we do not feel that esophagoscopy is always indicated as part of the initial workup for all head and neck cancer patients. Rather, we consider the barium swallow esophagogram to be a relatively safe and acceptably accurate alternative in most cases, with esophagoscopy reserved for specific indications.

Barium Sulfate↗

PubMed2003

Is same-day discharge suitable following rigid esophagoscopy? Findings in a series of 655 cases.

It has been suggested that more otolaryngologic procedures should be performed on an outpatient basis, and that rigid upper aerodigestive tract endoscopy might be a particularly suitable procedure in this regard. To determine if this is indeed the case, we retrospectively reviewed the records of 563 patients who had undergone 655 rigid esophagoscopies in our unit between Jan 1, 1991, and July 31, 1998. We ascertained the rate of complications (primarily esophageal perforation) following such procedures and, when they did occur, we determined the length of time between surgery and the onset of the complications' signs and symptoms. Our aims were to establish the minimum duration of postoperative observation that is required following esophagoscopy and to propose criteria for safe same-day discharge. We found that perforation rates were 4.5% following therapeutic procedures (dilation, biopsy, and foreign-body removal) and 1.2% following diagnostic procedures. In 40% of the patients who experienced perforations, no such signs or symptoms were noted within the first 8 hours following surgery. This finding has important implications for surgeons who wish to perform rigid esophagoscopy on an outpatient basis.

Adolescent↗

PubMed1976

[Indications and limitations of esophagoscopy with flexible fiberoptics (author's transl)].

The authors evaluate the results of 241 diagnostic esophagoscopies with fiberoptics performed in the years 1973/74. The fiberoptics were successfully used in 208 patients (86%) suffering of inflammatory processes of the esophagus, hiatus hernias, carcinomas and spontaneous or traumatic bleeding of the esophagus. In 33 cases (14%) the fiberoptics were not sufficient in establishing a diagnosis and had to be followed by a classical esophagoscopy. This was necessary in stenosis of the esophagus, pathological changes in the area of the esophageal entrance and marked suprastenotic dilatations of the esophagus with food retention. It is concluded that in esophageal diagnostics in addition to flexible fiberoptics there is still a need for the classical instruments like metallic esophagoscopy tubes of different length and lighting.

Esophageal Diseases↗

PubMed1976

[Mistakes and complications by the esophagoscopy].

The most frequent and typical mistakes, complications are specialties of esophagoscopy are reported. They are documented by some examples of the endoscopical practise. Mainly it is referred to the history, the inspection previous to the esophagoscopy, the preparation and the technique of the esophagoscopy. The cases concerning the removal of the foreign bodies dangerous to the esophagus and the obligation to inform the patient are emphasized.

Anesthesia, General↗

PubMed2000

Thoracoscopic enucleation of benign tumors of the esophagus under simultaneous flexible esophagoscopy.

BACKGROUND: Benign tumors of the esophagus are very rare, accounting for only 0.1-2% of all esophageal tumors. Conventional treatment consists of thoracotomy adapted to the location of the tumor, followed by enucleation of the lesion. This approach, however, involves major surgery. Minimally invasive surgery represents a viable therapeutic alternative, in particular for benign tumors. METHODS: In four patients with a benign tumor of the esophagus, we carried out thoracoscopic enucleation under simultaneous esophagoscopy. RESULTS: Using this combination of endoscopic procedures, the tumors were removed reliably and safely. Two of the lesions were intramural leiomyomas, and two were intramural myxoid cysts. CONCLUSION: This combination of endoscopic procedures represents a minimally invasive approach with correspondingly minor surgical trauma. Using simultaneous esophagoscopy and transillumination (diaphanoscopy) of the esophageal wall, the safety and accuracy of the dissection is increased, and the risk of mucosal perforation minimized.

Esophageal Neoplasms↗

PubMedDate not supplied

Treatment of a radiation-induced esophageal web with retrograde esophagoscopy and puncture.

OBJECTIVE: To present a technique for the treatment of complete esophageal stenosis in the post-radiation patient that may be applied to selected patients with obstructing stenoses. STUDY DESIGN: A case report of the treatment of a post-radiation esophageal web. METHODS: A review of the patient's history of treatment and a discussion of reported treatment options. RESULTS: A complete obstruction of the cervical esophagus was diagnosed in a patient after chemoradiation for a hypopharyngeal carcinoma. Retrograde esophagoscopy through the patient's percutaneous endoscopic gastrostomy tube site aided visualization and perforation of the obstructing tissue. Subsequent dilation has allowed the patient to resume oral intake of a regular diet without restrictions. CONCLUSION: Combined direct laryngoscopy with retrograde esophagoscopy represents a viable alternative to more extensive approaches for recannulization of selected obstructing esophageal stenoses.

Carcinoma, Squamous Cell↗

PubMed2004

Wireless pH testing as an adjunct to unsedated transnasal esophagoscopy: the safety and efficacy of transnasal telemetry capsule placement.

OBJECTIVES: The introduction of 48-hour wireless pH testing offers clinicians a new alternative for the objective documentation of reflux. The success of transnasal wireless pH capsule placement has not been previously described. The purpose of this investigation was to describe our experience with transnasal wireless pH capsule placement. METHODOLOGY: All patients undergoing unsedated transnasal esophagoscopy and wireless pH capsule placement between January 1, 2003 and July 31, 2003 were prospectively evaluated. Data concerning patient tolerance, success of capsule placement and function, complications, and pH recordings were collected. RESULTS: During this time, 46 persons were evaluated. The mean age of the cohort was 52 years. Of the patients, 50% were male. The indications for the procedure were chronic cough (18/46), gastroesophageal reflux disease (18/46), and larygopharyngeal reflux (10). Of the procedures performed, 85% (39/46) were successful. Complications included epistaxis (2/46), laryngospasm (2/46), and vasovagal reaction (1/46). CONCLUSIONS: The transnasal placement of a wireless pH capsule is a safe and effective diagnostic adjunct to unsedated transnasal esophagoscopy.

Capsules↗

PubMed2004

Is esophagoscopy alone sufficient for patients with reflux symptoms?

BACKGROUND: Unsedated esophagoscopy with ultrathin endoscopes is a valuable screening modality for Barrett's esophagus, but the stomach and the duodenum cannot be examined completely with the smallest and best tolerated of these endoscopes. There are no data as to how often disease in the stomach and the duodenum would be missed when using this screening strategy. Our hypothesis is that patients with reflux symptoms, in the absence of daily abdominal pain, nausea, or history of ulcer, were unlikely to have clinically significant gastroduodenal disease. METHODS: Patients scheduled for upper endoscopy at a single outpatient endoscopy unit in a tertiary referral center were screened. The inclusion criterion was reflux symptoms as the primary indication for upper endoscopy. Patients with another valid indication were excluded. A detailed history was recorded and symptom questionnaire completed for each patient before endoscopy; these data were compared with the endoscopy findings. RESULTS: A total of 175 patients were included. Indications for upper endoscopy were the following: worsening symptoms (n=74), ongoing reflux despite therapy (n=27), and long-standing reflux (n=74). Major esophageal findings were discovered in 95 patients. In 10 patients, major gastric or duodenal findings were detected as follows: erosive gastritis (n=8), gastric ulcer (n=2), duodenal ulcer (n=2), erosive duodenitis (n=2), and duodenal polyp (n=1). Daily abdominal pain (p=0.014) or possibly daily nausea (p=0.028 unadjusted, 0.197 adjusted) was associated with major gastric/duodenal disease. Patients without daily abdominal pain, nausea, or a history of gastric/duodenal ulcer were much less likely to have major disease (0.9%) than patients with one of these predictors (13.2%, p=0.00097). CONCLUSIONS: Daily abdominal pain and nausea, in combination with a history of ulcer disease, are strong predictors of major gastric or duodenal disease. Patients with reflux without these predictors are highly unlikely to have a major disease involving the stomach or duodenum, and are suitable candidates for esophagoscopy alone.

Adult↗

PubMed2000

Unsedated esophagoscopy for the diagnosis of esophageal varices in patients with cirrhosis.

BACKGROUND AND STUDY AIMS: Unsedated endoscopy with ultrathin endoscopes has been shown to be an alternative to conventional endoscopy. This technique would appear to be an ideal way to screen for varices, but there is scant data for unsedated endoscopy in patients with cirrhosis. The aims of this pilot study were to evaluate whether unsedated endoscopy can be used to screen for varices and to determine how well it is tolerated in patients with hepatic dysfunction. PATIENTS AND METHODS: We prospectively evaluated unsedated esophagoscopy in 15 patients with cirrhosis who were candidates for beta-adrenergic-antagonist therapy. Patients with cirrhosis without gastrointestinal bleeding or contraindications to beta-adrenergic-antagonist therapy gave consent to the procedure. The presence and size of varices and the procedure time were recorded. After the procedure, patient tolerance, as gauged by questionnaire and willingness to repeat, was assessed. RESULTS: All patients tolerated the procedure without significant discomfort. The mean time of the procedure was 2 minutes. Esophageal varices were found in nine of 15 patients. Of these, one patient with Child-Pugh class C cirrhosis had large varices and was started on propranolol. CONCLUSIONS: Unsedated esophagoscopy in patients with cirrhosis appears to be well tolerated. Given both potential safety and cost benefits over conventional endoscopy, this could be a useful method for screening for varices. A randomized trial comparing this method with standard endoscopy is warranted.

Procedural Sedation↗