Safety of flexible endoscopic biopsy of the pharynx and larynx under topical anesthesia

Abstract

Recent advancements in transnasal endoscopy enable a shift in diagnostic workup of lesions in the pharynx and larynx, from an examination with biopsy under general anesthesia to an office-based examination with flexible endoscopic biopsy under topical anesthesia. Procedural complications were evaluated to assess the safety of office-based flexible endoscopic biopsy in patients with benign and malignant laryngopharyngeal lesions. Patients who underwent flexible endoscopic biopsy from 2012 to 2016 were evaluated retrospectively. Complications were classified using the Clavien–Dindo classification of surgical complications. A total of 201 flexible endoscopic biopsies were performed in 187 patients. Two Clavien–Dindo grade I (laryngospasm and anterior epistaxis), one grade II (laryngeal bleeding), and one grade IIIb (laryngeal edema) complication were observed. The first complication was self-limiting and the other three required an intervention. All patients fully recovered without sequelae. Flexible endoscopic biopsy appears to be a safe office-based procedure for the diagnosis of benign and malignant laryngopharyngeal lesions.

Impact of optimizing diagnostic workup and reducing the time to treatment in head and neck cancer

“…OBB is well tolerated and safe. [16][17][18][19][20][21] Studies have shown that when the histological outcome of OBB has been invasive squamous cell carcinoma, the diagnosis has been confirmed in 100% of the cases with a final histological diagnosis using operative biopsies. [21][22][23] Median specialist-to-diagnosis and specialist-to-treatment intervals were significantly decreased from 9 to 2 days and from 34 to 21 days, respectively.…”

Office‐based CO2 laser surgery for benign and premalignant laryngeal lesions

“…Office‐based laryngeal procedures in general have shown to be feasible, safe, and well tolerated by patients. They result in decreased time intervals to diagnosis and treatment and also reduce healthcare costs . In patients with benign laryngeal pathology and a contraindication for general anesthesia or with a lesion inaccessible by rigid endoscopy (e.g., patients with limited neck extension or dental limitations), office‐based CO 2 laser surgery is a minimally invasive therapeutic alternative.…”

“…Reasons for undergoing an office‐based procedure were either contraindications for general anesthesia, previously failed therapeutic laryngoscopy under general anesthesia, or a strong preference for a procedure under topical anesthesia by the patient. Patients underwent flexible endoscopic biopsy (FEB) under topical anesthesia to obtain histology prior to office‐based laser surgery according to our department's protocol . An exception was if patients with a medical history of a benign laryngeal tumor (e.g., laryngeal papilloma) were seen with suspicion of recurrent disease during flexible laryngoscopy.…”

“…Patients were treated in our outpatient clinic surgical procedure room. Patients were instructed and anesthetized (nasal cavity and oropharynx) according to our department's protocol . At the beginning of the study, laryngeal anesthesia was provided by injection through the cricothyroid membrane with 1.0 mL 10% lidocaine.…”

Transoral Versus Transnasal Approaches in Office-Based Laryngeal Biopsy: A Cohort-Selection Cross-Sectional Diagnostic Accuracy Study

“…14 Our study showed very few postprocedural complications in both approaches as well as good tolerance of patients which agrees with other studies. 4,6,15 However, Shah and Johns reported that the transoral approach can be difficult to perform and is not well tolerated by some patients. On the other hand, transnasal access is generally better tolerated by most patients.…”