Practice points
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Screening of the laryngopharyngeal area by routine upper endoscopy can reveal significant asymptomatic lesions.
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).
Between June 2006 and February 2008, 1297 patients undergoing elective UGI endoscopy for the first time were included in the study to investigate the efficacy of endoscopic screening of the laryngopharyngeal area. The study protocol was approved by the Ethics Committee of our hospital and written informed consent was obtained from all patients.
Symptomatic patients reported sore throat, hoarseness, or difficulty in swallowing; those with a known pathology in this area or patients undergoing
During the study period, routine UGI endoscopies were performed for the first time in 1297 patients without symptoms in the laryngopharyngeal area. In 167 patients (12.88%), an adequate inspection of the laryngopharyngeal area could not be performed before the insertion of the endoscope into the oesophagus, because of excessive gagging; these cases were excluded from the study. Therefore, a successful examination was performed in 1130 patients (87.12%). Table 1 shows the patients’
This is the first prospective study which attempted to examine the laryngopharyngeal area during routine UGI endoscopy before insertion of endoscope into oesophagus; only asymptomatic, in the laryngopharyngeal area, patients were included. Our series has shown that cautious examination of the laryngopharyngeal area may provide significant clinical findings. Indeed, pathological findings were observed in 4.6% of our cases; this is higher than the rate ranged from 0.9% to 3.5% reported in
Our series showed that, by using a little extra time to inspect the laryngopharyngeal area during a routine UGI endoscopy, significant asymptomatic lesions can be revealed. The introduction of high-resolution endoscopy in daily practice will open new horizons in the detection of lesions not visible by conventional endoscopy. Screening of the laryngopharyngeal area by routine upper endoscopy can reveal significant asymptomatic lesions. Introduction of high-resolution endoscopy in daily practicePractice points
Research agenda
None declared.
They proposed a classification system for grading findings on endoscopy to facilitate more accurate diagnosis of LPR in this patient population. Katsinelos et al43 reported that the laryngopharynx is not examined routinely during esophagogastroduodenoscopy (EGD). Their prospective study found significant laryngeal pathology including leukoplakia, Reinke edema, and posterior laryngitis in their patients, and they recommended screening examinations of the laryngopharynx during all EGD procedures.