[Dangers of esophagoscopy (observed on 4,383 esophagoscopies].
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Esophageal Perforation↗
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[Difficulties and complications of esophagoscopy (in a series of 3,120 consecutive esophagoscopies)].
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Esophagoscopy↗
Safety of esophagoscopy in the irradiated esophagus.
Carcinoma of the esophagus is a disease with a poor prognosis. Surgery is considered the treatment of choice. Patients who are surgically unresectable may receive radiotherapy, plus or minus chemotherapy. While this offers reasonable palliation, a significant number of patients develop benign or malignant strictures. Frequent esophagoscopy with dilation is required if they are to swallow. Patients with strictures or malignancy of the esophagus are more prone to complications if they undergo an esophagoscopy. We examined the morbidity of esophagoscopy in a group of patients who had received radiotherapy for carcinoma of the esophagus. Over a 10-year period, 21 patients receiving irradiation for carcinoma of the esophagus were examined. All patients underwent esophagoscopy for staging and diagnosis. The tumor locations were upper (6), middle (6), and lower (9) esophagus. The T-stages were 1 (7), 2 (6), 3 (6), and 4 (2). Five patients had dilation of a malignant stricture at the time of diagnosis. Fever developed and resolved within 24 hours in 2 patients. Following completion of irradiation, a total of 83 esophagoscopies were performed (range 1 to 11 per patient). Six patients with no tumor or stricture underwent 8 esophagoscopies (3 rigid, 5 flexible). There was 1 episode of minimal bleeding and 1 fever that resolved within 24 hours. Ten patients with malignant strictures underwent 62 esophagoscopies (5 rigid, 57 flexible). There were 17 (27%) episodes of fever (all resolved within 24 hours) and 14 (22%) episodes of bleeding. Five patients with benign strictures underwent 13 esophagoscopies (2 rigid, 11 flexible). One patient had a perforation that resolved with conservative treatment, and 1 patient developed an epidural abscess 2 months following dilation. This patient is the only one that required surgical intervention and had prolonged hospitalization. Esophagoscopy of the irradiated esophagus can be performed relatively safely and excellent palliation obtained. Morbidity consisting of minimal bleeding, and fever lasting less than 24 hours, is frequent but self-limited.
Adult↗
Negative findings of esophagoscopy for suspected foreign bodies.
PURPOSE: Suspected impaction of esophageal foreign bodies may at times pose a diagnostic problem as to the decision to perform esophagoscopy. It is not unusual to perform a rigid esophagoscopy following a diagnostic work-up for an impacted foreign body and not to find one. This study attempts to delineate the clinical situations where negative esophagoscopies are more likely to occur. MATERIALS AND METHODS: In a retrospective analysis of 98 rigid esophagoscopies performed for suspected foreign bodies in our department, an attempt was made to delineate the clinical and radiologic findings characteristic of the patients who had no foreign body at esophagoscopy compared with the patients in whom a foreign body was found. RESULTS: Negative esophagoscopies were associated with suspected bone (mostly fish) impaction in 20 of the 22 negative esophagoscopies. Other parameters associated with negative findings were prolonged duration of symptoms and a positive finding at the physical examination. In suspected bone impaction, barium studies and neck x-rays were not helpful in determining the presence of a foreign body. CONCLUSION: Clinical history is the main indicator in the decision to perform esophagoscopy for suspected foreign bodies.
Bone and Bones↗
[Tracheobronchoscopy and esophagoscopy in otorhinolaryngology. An assessment of current status].
Its is the task of each medical specialty to develop guidelines for diagnosis and therapies. Examinations done by several specialties should follow a common consensus. A randomized survey at 70 German ENT departments investigated the current position of tracheobronchoscopy and esophagoscopy at each institution. Sixty questionnaires were evaluable. Altogether 8,295 tracheobronchoscopies and 10,404 esophagoscopies were performed. Thirty-six percent of all tracheobronchoscopies and 6% of all esophagoscopies were done with a flexible system. Approximately 58% of all tracheobronchoscopies and 55% of all esophagoscopies were performed for tumor staging. Complications during tracheobronchoscopy occurred in 0.8% of cases and in 0.58% of the esophagoscopies. Using these data an interdisciplinary quality assurance concept was developed for tracheobronchoscopy and esophagoscopy. Current experience has shown that a otolaryngologists in Germany mainly perform rigid tracheobronchoscopy and esophagoscopy. Although endoscopy is mostly done in cases with varied anatomic structures, complications are very rare and comparable to flexible techniques. Greater experience with flexible systems also is to be encouraged in ENT departments.
Bronchoscopes↗
Open tube versus flexible esophagoscopy in adult head and neck endoscopy.
Open tube esophagoscopy is the mainstay of otolaryngic esophageal examination. Over the last 30 years flexible endoscopes have become popular and are challenging the open tube esophagoscope for use in otolaryngic practice. This study examines all open tube esophagoscopies performed on adult patients at the University of Pennsylvania over an 8-year period for the diagnosis and treatment of foreign bodies, strictures, functional disorders, and carcinoma. Open tube esophagoscopy is most useful for foreign body extraction, examination of the cervical esophagus, and dilation of pliable strictures. For most other indications flexible esophagoscopy provides improved visualization with lower morbidity. For patients with squamous cell carcinoma of the head and neck we found a 1.4% incidence of secondary esophageal malignancies and a 28% incidence of false-negative barium swallow studies. We recommend esophagoscopy for all patients with carcinoma of the upper aerodigestive tract. The otolaryngologist should be adept at both flexible and open tube esophagoscopy in order to allow optimal examination of and therapeutic intervention in the upper aerodigestive tract.
Barium Sulfate↗
Esophagography and esophagoscopy. Comparison in the examination of patients with head and neck carcinoma.
We carried out a prospective, double-blind study at three institutions, comparing esophagography with esophagoscopy for the detection of simultaneous cancer of the esophagus in patients with other squamous cell cancers of the head and neck. The goal was to determine whether esophagography and esophagoscopy are necessary for the examination of patients before treatment. One hundred eighty-two patients were studied; both examinations were done in 148 patients. Twenty-one patients could not undergo esophagoscopy; esophagography was inadequate in 9 patients; 4 patients could have neither examination. Concordance was noted between the two procedures in 86.5% of patients. Sixty-five percent were normal, and 21.5% were abnormal. One esophageal cancer was found in this series that was diagnosed by both methods. Our data suggest that esophagoscopy and esophagography may be complementary in evaluating squamous cell carcinoma of the head and neck in patients before treatment. Esophagography alone was useful in patients in whom esophagoscopy could not be performed.
Adult↗
Geographic variation in the utilization of esophagoscopy and bronchoscopy in head and neck cancer.
OBJECTIVE: To determine the extent to which esophagoscopy and bronchoscopy are being used in various regions of the United States in the initial examination of patients with head and neck cancer. DESIGN: Population-based study derived from Medicare claims data and information from the National Cancer Institute's Surveillance, Epidemiology, and End Results (SEER) Program. SETTING: Five SEER areas (San Francisco, Calif; Connecticut; Seattle, Wash; Iowa; and Detroit, Mich). PARTICIPANTS: The cohort included 1410 Medicare patients with squamous cell carcinoma of the oral cavity, oropharynx, hypopharynx, or larynx diagnosed between March 1, 1991, and December 31, 1993, in the 5 SEER areas. MAIN OUTCOME MEASURE: Rates of esophagoscopy and bronchoscopy according to SEER area. RESULTS: The proportion of patients who underwent esophagoscopy ranged from 12.9% (San Francisco) to 39.8% (Detroit) for patients with local cancer and from 22.2% (San Francisco) to 59.7% (Detroit) for patients with regional cancer. The proportion of patients who underwent bronchoscopy ranged from 6.9% (San Francisco) to 32.6% (Detroit) for patients with local cancer and from 12.8% (San Francisco) to 50.7% (Detroit) for patients with regional cancer. After controlling for differences in age, sex, race, tumor site, tumor grade, comorbidity, and socioeconomic status, SEER area remained independently associated with esophagoscopy and bronchoscopy (both P < .001). CONCLUSIONS: There is substantial geographic variation in the use of esophagoscopy and bronchoscopy as part of the initial examination of patients diagnosed as having head and neck cancer that cannot be explained by differences in patient or tumor characteristics. This variation likely underscores uncertainty and disagreement about the value of endoscopic screening for synchronous tumors. Additional research is required to determine whether routine endoscopic screening increases survival rates or improves quality of life.
Aged↗
Esophagoscopy and endoscopic esophageal ultrasound in the assessment of esophageal function.
Esophagoscopy is an ideal method to detect mucosal or structural abnormalities of the esophagus and proximal stomach. The exclusion of malignant dysphagia is the prime role of esophagoscopy in assessment of esophageal function. Esophagoscopy and biopsy are mandatory for mucosal assessment of patients with gastroesophageal reflux disease (GERD). Indirect and sometimes subtle evidence of abnormal esophageal motility is a valuable and underused aspect of esophagoscopy in the evaluation of swallowing disorders. Esophagoscopy has multiple roles in the appraisal and treatment of esophageal motility disorders, including the detection of secondary or pseudoachalasia, placement of manometry catheters, and dilation of peptic strictures caused by GERD associated with disorders such as scleroderma.
Diverticulum, Esophageal↗
Accuracy of esophagoscopy performed by a non-physician endoscopist with a 4-mm diameter battery-powered endoscope.
BACKGROUND: A cost-effective technique is needed for screening of a broad population at risk for esophageal cancer. A solution would be to have non-physician endoscopists perform esophagoscopy with small-caliber battery-powered endoscopes. METHODS: In a prospective blinded study, the diagnostic accuracy of sedated esophagoscopy performed by a trained nurse practitioner with a battery-powered 4-mm diameter endoscope was compared with that for a sedated standard video-endoscopy performed by a gastroenterologist. Patients were recruited to undergo peroral esophagoscopy by the nurse practitioner followed by sedated standard endoscopy by the supervising gastroenterologist, each blinded to the findings of the other. Major esophageal findings of nurse practitioner and gastroenterologist were compared. RESULTS: Findings in 40 patients were analyzed. In 4 patients both endoscopists could not assess the presence or absence of columnar-lined esophagus because of severe erosive esophagitis (n = 3) or severe candida-esophagitis (n = 1). By using sedated standard endoscopy as the standard, on a per finding basis, esophagoscopy by the nurse practitioner had a sensitivity for columnar-lined esophagus of 89%: 95% CI [75%, 97%] and specificity of 96%: 95% CI [84%, 99%]. The missed columnar epithelium was a 3 x 3-mm island. For all lesions, the sensitivity of endoscopy performed by the nurse practitioner with the battery-powered endoscope was 75%: 95% CI [67%, 82%] and specificity 98%: 95% CI [96%, 99%]. The nurse practitioner missed all of 4 rings (3 considered clinically irrelevant). CONCLUSION: Esophagoscopy with a battery-powered 4-mm diameter endoscope by a non-physician endoscopist is feasible and accurate in detecting esophageal pathologies. It may be an efficient screening method for the detection of columnar-lined esophagus. There was a distinct underestimate of the presence of esophageal rings.
Barrett Esophagus↗
Esophagitis in the immunocompromised host: role of esophagoscopy in diagnosis.
Thirty episodes of presumed infectious esophagitis in immunocompromised patients were investigated by means of esophagoscopy. Indications for esophagoscopy included dysphagia, odynophagia, and retrosternal pain. Factors potentially predisposing patients to esophagitis included previous exposure to radiation, recent cytotoxic chemotherapy, recent antibiotic therapy, corticosteroid therapy, and neutropenia. Sixteen of the 18 barium esophagograms done before esophagoscopy was performed revealed abnormalities; in 14 cases the results were consistent with infectious esophagitis. Abnormalities were noted during 27 of 30 esophagoscopy procedures. Visual findings were consistent with candidal esophagitis in 18 cases, with viral esophagitis in four, and with both in one. Specific infectious diagnoses were established by culture or histology in 17 episodes: 12 of candidal esophagitis, two of herpes simplex esophagitis, two of concomitant candidal and herpetic esophagitis, and one of enteroviral esophagitis. Specific noninfectious diagnoses were made in two episodes, and the esophagus was found to be normal in three. No specific diagnosis was made in eight episodes although visual examination indicated the presence of esophagitis. The only postesophagoscopy complications recorded were isolated episodes of spiking fever in three patients. In this compromised-host population with presumed infectious esophagitis, esophagoscopy resulted in a rapid and specific infectious diagnosis in 57% of episodes.
Adolescent↗
Comparison of rigid and flexible esophagoscopy in the diagnosis of esophageal disease: diagnostic accuracy, complications, and cost.
Rigid esophagoscopy has been used by otolaryngologists for evaluation of the esophagus for over 100 years. Few studies have examined the diagnostic accuracy of rigid esophagoscopy in patients with carcinoma of the head and neck. The goal of our study was to compare the diagnostic accuracy, complication rate, and costs of rigid esophagoscopy and flexible fiber-optic endoscopy in the evaluation of the esophagus in patients with head and neck carcinoma. We retrospectively reviewed the records of 195 patients with head and neck carcinoma who underwent both rigid esophagoscopy and flexible fiber-optic endoscopy within a 6-month period. We discovered 10 cases with discordant findings, of which 5 (50%) were esophageal carcinoma. The estimated cost was less for flexible endoscopy. No complications were reported in either procedure. Our study suggests that flexible fiber-optic endoscopy should replace rigid esophagoscopy in the evaluation of the esophagus in patients with head and neck carcinoma.
Cost-Benefit Analysis↗
The role of esophagoscopy in diagnosis and management of esophagitis in children with cancer.
Esophagitis is a common complication in patients treated for cancer; however, difficulty in determining its etiology on the basis of noninvasive clinical information limits the implementation of specific therapies. We reviewed our experience with esophagoscopy and biopsy as an aid in the diagnosis and management of esophagitis in children with cancer. Of eleven episodes of esophagitis evaluated by esophagoscopy with biopsy, four (36%) had an infectious etiology (two with Candida, one with Herpes simplex virus, and one with viridans streptococci). The absolute neutrophil count, presence of oropharyngeal colonization, and appearance of the esophagus at esophagoscopy were not predictive of the etiology of esophagitis. Esophagoscopy with biopsy affected the management of 4 (36%) patients. We believe this procedure to be a valuable aid in managing esophagitis in children with cancer by providing objective data not otherwise available to the clinician.
Adolescent↗
Prospective evaluation of 4-mm diameter endoscopes for esophagoscopy in sedated and unsedated patients.
BACKGROUND: Unsedated esophagoscopy with small-diameter endoscopes is generally well tolerated but of limited sensitivity for the diagnosis of esophageal mucosal disease. This study evaluated the sensitivity of esophagoscopy performed with new 4-mm diameter prototype battery-powered and video endoscopes. Patient tolerance for an unsedated examination with the 4-mm endoscopes was assessed and the performance characteristics of the battery-powered and video 4-mm endoscopes were compared. METHODS: Patients referred for EGD were recruited to undergo an additional examination with a 4-mm endoscope. A prototype 60-cm long, 4-mm diameter battery-powered fiberoptic esophagoscope was used in the first 24 patients and a prototype 60-cm long, 4-mm diameter video esophagoscope in the next 27 patients. Examiners who were unaware of patient history and procedure indications recorded esophageal findings, ease of intubation, optical quality (5-point visual scale), and time for examination of the esophagus and then recorded esophageal findings after the standard EGD. RESULTS: The sensitivity, specificity, and accuracy for identification of Barrett's esophagus was 100%; overall sensitivity, accuracy, and specificity for detecting esophageal lesions were, respectively, 91%, 98%, and 99%. Patient tolerance (assessed by symptom scores for choking, pain, and discomfort) and acceptability of unsedated esophagoscopy with the 4-mm diameter instruments were significantly better than in a historical group of patients examined with a 3-mm diameter endoscope. The optical quality of video endoscope was rated as superior to that of battery-powered endoscope, and esophageal examination was performed significantly quicker with the video versus the battery-powered endoscope (68 vs. 137 seconds; p = 0.001). CONCLUSIONS: Unsedated esophagoscopy with 4-mm diameter endoscopes may be an alternative to EGD for screening for Barrett's esophagus. Given the current state of endoscopic technology, a minimum diameter of 4 mm is required for satisfactory esophageal imaging.
Barrett Esophagus↗
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↗
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↗
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↗
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↗