Efficacy of endoscopy under general anesthesia for the detection of synchronous lesions in oro-hypopharyngeal cancer

Abstract

Background/Aims: Image-enhanced endoscopy can detect superficial oro-hypopharyngeal squamous cell carcinoma; however, reliable endoscopy of the pharyngeal region is challenging. Endoscopy under general anesthesia during transoral surgery occasionally reveals multiple synchronous lesions that remained undetected on preoperative endoscopy. Therefore, we aimed to determine the lesion detection capability of endoscopy under general anesthesia for superficial oro-hypopharyngeal squamous cell carcinoma. Methods: This retrospective study included 63 patients who underwent transoral surgery for superficial oropharyngeal squamous cell carcinoma between April 2005 and December 2020. The primary endpoint was to compare the lesion detection capabilities of preoperative endoscopy and endoscopy under general anesthesia. Other endpoints included the comparison of clinicopathological findings between lesions detected using preoperative endoscopy and those newly detected using endoscopy under general anesthesia. Results: Fifty-eight patients (85 lesions) were analyzed. The mean number of lesions per patient detected was 1.17 for preoperative endoscopy and 1.47 for endoscopy under general anesthesia. Endoscopy under general anesthesia helped detect more lesions than preoperative endoscopy did (p<0.001, paired t-test). The lesions that were newly detected on endoscopy under general anesthesia were small and characterized by few changes in color and surface ruggedness. Conclusions: Endoscopy under general anesthesia for superficial squamous cell carcinoma is helpful for detecting multiple synchronous lesions.

Endoscopy under general anesthesia for detecting synchronous lesions of head and neck squamous cell carcinoma

“…Therefore, detailed observation of the oro-hypopharyngeal area during routine screening endoscopy is necessary. As demonstrated by Ono et al, 13 endoscopy under GA, along with panendoscopy, is helpful when selectively performed in patients stratified as having a high risk for recurrence.…”

“…Ono et al 13 reported the capability of endoscopy under general anesthesia (GA), compared with that of conventional sedated endoscopy, for detecting superficial oro-hypopharyngeal SCC lesions. The mean number of lesions detected per patient was significantly higher on endoscopies performed under GA than on endoscopies performed under conventional sedation (1.47 vs. 1.17, p <0.001).…”

Nasopharyngeal examination during transoral upper gastrointestinal endoscopy

“…They showed that newly detected lesions were small and characterized by few changes, color, and surface ruggedness. 1 These findings are important but not surprising, considering that transoral endoscopy with topical anesthesia can be uncomfortable. Even with conscious sedation, it can easily induce the gag reflex and make subsequent examination difficult.…”

“…To the Editor, I read with interest the article by Ono et al 1 and the corresponding editorial by Noh and Kim 2 published in the recent issue of Clinical Endoscopy. Ono et al 1 studied patients with hypopharyngeal squamous cell carcinoma scheduled for transoral resection under general anesthesia and found more lesions (1.47 lesions/patient) during detailed assessment just before resection compared to previous transoral endoscopy (1.17 lesions/patient) done with or without sedation. They showed that newly detected lesions were small and characterized by few changes, color, and surface ruggedness.…”