Case of Superficial Cancer Located at the Pharyngoesophageal Junction Which Was Dissected by Endoscopic Laryngopharyngeal Surgery Combined with Endoscopic Submucosal Dissection

Abstract

Aims. In order to determine the indications of transoral surgery for a tumor located at the pharyngoesophageal junction, the trumpet maneuver with transnasal endoscopy was used. Its efficacy is reported here. Material and Methods. An 88-year-old woman complaining of dysphagia, diagnosed with cervical esophageal cancer, and hoping to preserve her voice and swallowing function was admitted to our hospital. Conventional endoscopy showed that the tumor had invaded the hypopharynx. When inspecting the hypopharynx and the orifice of the esophagus, we asked the patient to blow hard and puff her cheeks with her mouth closed (trumpet maneuver). After the trumpet maneuver, the pharyngeal mucosa was stretched out. The pedicle of the tumor arose from the left-anterior wall of the pharyngoesophageal junction, so we decided to perform endoscopic resection. Result. Under general anesthesia, the curved laryngoscope made it possible to view the whole hypopharynx, including the apex of the piriform sinus and the orifice of the esophagus. The cervical esophageal cancer was pulled up to the hypopharynx. Under collaboration between a head and neck surgeon and an endoscopist, the tumor was resected en bloc by endoscopic laryngopharyngeal surgery combined with endoscopic submucosal dissection. Conclusion. Transnasal endoscopy using the trumpet maneuver is useful for a precise diagnosis of the pharyngoesophageal junction. Close collaboration between head and neck surgeons and endoscopists can provide good results in treating tumors of the pharyngoesophageal junction.

Issues and controversies in esophageal inlet patch

“…NBI systems can be very helpful to identify brownish areas with brown dots and branching vessels in the cervical esophagus as potential superficial esophageal cancers. Therefore, the combined application of magnification and NBI can help to inform and direct the diagnostic management and early detection of esophageal neoplasia[55]. Magnifying endoscopy with the NBI system is superior to conventional white-light endoscopy for the detection of early cancers and helps to resolve the microvascular patterns of the superficial esophageal mucosa[56,57].…”

Heterotopic gastric mucosa (inlet patch): Endoscopic prevalence and association with supraesophageal and upper esophageal symptoms

“…With detailed examination of the proximal esophagus, inlet patch diagnostic efficiency can be increased. In addition, the use of NBI can increase the frequency and accuracy of diagnosis [10][11][12] . In our own experience, we have seen that the most important event that increases the frequency of inlet patch diagnosis is a detailed examination of the esophagus proximal.…”

Comparative Study of Predictive Mortality Scores in Esophagectomy with Three-Field Lymph Node Dissection in Patients with Esophageal Cancer

“…Endoscopic procedures can be performed in many cases, and specific procedures leading to the initial diagnosis with adequate treatment have shown good results [27]. Patients who have tumors in the early stages can undergo resection via endoscopic procedure, and if there is lymph or vascular invasion on the histopathological result, surgery is mandatory.…”