Should inspection of the laryngopharyngeal area be part of routine upper gastrointestinal endoscopy? A prospective study

Abstract

Background

Examination of the laryngopharyngeal area is not always performed during routine upper gastrointestinal (UGI) endoscopy although initial studies reported pathological findings in 0.9–3.5% of cases. The aim of this study was to prospectively evaluate the accuracy of screening the laryngopharyngeal area during routine UGI endoscopy, before insertion of endoscope into the oesophagus, to avoid a misinterpretation of trauma-related hyperaemia or erythema as signs of laryngitis.

Methods

The study included 1297 patients undergoing elective UGI endoscopy, asymptomatic in the laryngopharyngeal area, who underwent a carefully structured examination of the laryngopharyngeal area, videotaped for later blinded review. If pathological findings were suspected, patients were referred to otorhinolaryngologists for additional evaluation. In all cases the DVDs were reviewed by two ear, nose, and throat (ENT) specialists blinded to the endoscopic findings.

Results

In 1130 (87.12%) patients the examination was performed successfully before insertion of the endoscope into the oesophagus. Gastro-oesophageal reflux disease (GORD) symptoms were present in 254 (22.5%) patients, and erosive oesophagitis was documented in 89 (7.9%) patients. In 44 (3.89%) patients the pathology was suspected by the endoscopist and confirmed by the otorhinolaryngologists. Moreover, 8 (0.71%) patients were found to have laryngeal pathology in the DVDs reviewed by the ENT specialists, further confirmed by laryngoscopy. Sensitivity, specificity, positive, and negative predictive values were 84.61%, 100%, 100%, and 99.26%, respectively, for detecting laryngeal abnormalities by the endoscopist. The most important findings were leukoplakia (n = 4), posterior laryngitis (n = 16), Reinke's oedema (n = 2), and hyperkeratosis of arytenoid folds (n = 2). A strict correlation emerged between GORD and posterior laryngitis (75%) and between GORD and Reinke's oedema (100%), documented by pHmetry. A significant association was also observed between heavy smoking and leukoplakia (75%), and hypertrophy of pharyngeal tonsils (100%), respectively. All other findings were lesions without clinical significance.

Conclusions

Screening examination of the laryngopharyngeal area should be part of each UGI endoscopy revealing important laryngeal pathology.

Introduction

Despite the large number of upper gastrointestinal (UGI) endoscopies being performed yearly worldwide, there is no routine inspection of the laryngopharyngeal area. Screening of the pharynx and larynx is usually avoided, because of the additional discomfort to the patient by the endoscope remaining in the throat. However, careful observation of the throat enables endoscopists to detect diseases in this region. The importance of such a screening examination has been underlined in previous studies [1], [2], [3], [4], [5]; pathological findings were reported in 0.9–3.5% of cases [1], [3]. Nevertheless, in only two studies [4], [5] an ear, nose, and throat (ENT) specialist confirmed the pathology of the laryngopharyngeal area which was detected by the endoscopist.

The aim of this study was to investigate the accuracy of inspection of the laryngopharyngeal area during a routine UGI endoscopy before insertion of the endoscope in the oesophagus to avoid misinterpretation of trauma-related erythema or oedema from the endoscope as extraoesophageal manifestations of gastro-oesophageal reflux disease (GORD).