Laryngoscope. 2013 Apr;123(4):975-9.

Transnasal esophagogastroduodenoscopy for evaluation of upper gastrointestinal non-neoplastic disorders in patients with fresh hypopharyngeal cancer.

Wang CP, Tseng PH, Chen TC, Lou PJ, Yang TL, Hu YL, Ko JY, Hsiao TY, Lee YC.

Institute of Biomedical Engineering, College of Medicine and College of Engineering, National Taiwan University, Taipei, Taiwan.

 

ABSTRACT:

OBJECTIVES/HYPOTHESIS: Upper gastrointestinal (UGI) tract non-neoplastic disorders are detrimental to cancer treatment. This study is to evaluate the feasibility of transnasal esophagogastroduodenoscopy in the diagnosis of UGI disorders at the same time as the diagnosis of hypopharyngeal cancer and to provide the prevalence of UGI disorders in patients with fresh hypopharyngeal cancer.

STUDY DESIGN: A prospective cases series study.

METHODS: Patients with newly diagnosed hypopharyngeal cancer between 2007 and 2010 were enrolled. An endoscope (GIF-XP260N; Olympus Optical, Tokyo, Japan) without conscious sedation was transnasally used to evaluate from the pharynx to duodenum.

RESULTS: One hundred two patients were evaluated. Sixty-five patients had at least one UGI disorder: gastric/duodenal ulcers in 32; active Helicobacter pylori infection in 36; and erosive esophagitis in 20 patients, including Los Angeles classification grade A in eight patients, grade B in 10, grade C in one, and grade D in one. Of the abovementioned disorders, 45 patients had only one, 17 patients had two, and three patients had all of the above disorders. Neither age, sex, location, nor T classification of the hypopharyngeal tumor was associated with the presence of UGI disorders.

CONCLUSIONS: Transnasal esophagogastroduodenoscopy can be a single procedure to diagnose hypopharyngeal cancer and UGI disorders at one session. Approximately ⅔ of the patients with fresh hypopharyngeal cancer had either erosive esophagitis, active H. pylori infection, or gastric/duodenal ulcers.

Copyright © 2013 The American Laryngological, Rhinological, and Otological Society, Inc.

PMID: 23529882

 

Supplements:

Primary head and neck cancers, especially pharyngeal cancer, have a higher risk for primary esophageal cancer. In the past 6 years, we have demonstrated the feasibility of transnasal esophagogastroduodenoscopy (EGD) without conscious sedation, instead of rigid laryngoscopy and esophagoscopy under general anesthesia, to evaluate hypopharyngeal cancer with tissue diagnosis and to regularly screen the entire esophagus at the same time (Figure 1). In addition to the traditional esophagus, stomach, and duodenum, the anatomy of nasopharynx (Figure 2), oropharynx and larynx (Figure 3), and hypopharynx (Figure 4) can be examined in details. So, this procedure creates a bridge between otolaryngologists and gastroenterologists to collaborate with each other such that the patients may benefit from multidisciplinary treatment. We also demonstrated that NBI technique is really useful to improve the specificity and sensitivity of detection of esophageal cancer and precursor. Since 2007, more than 200 patients newly diagnosed hypopharyngeal cancer received this examination. Around 45% of the patients are found to have simultaneous esophageal lesions, including second primary esophageal invasive cancer in around 15%, esophageal dysplasia of various degrees in 10% and Lugol voided lesion in the other 20%. Compared with esophageal cancer diagnosed in general population in Taiwan, the stage of esophageal cancers in this cohort is significantly lower, which may indicate better survival. Compared with historic control and the cohort without esophageal screening, we also demonstrated the survival benefit of this new diagnostic approach due to the fact that the cohort receiving regular screening of the esophagus by use of transnasal EGD with NBI technique has a statistically significantly better survival. By the way, more than 60% of the patients with newly diagnosed hypopharyngeal cancer were diagnosed by transnasal EGD to have upper GI functional disorders, including peptic ulcers, reflux esophagitis and active Helicobacter pylori infection in the stomach (Figure 5). It may be beneficial to improve the patients’ quality of life if taking care of these functional disorders when treating cancer.

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