Use of transoral endoscopy for pharyngeal examination: <scp>C</scp>ross‐sectional analysis

Tsuji, Kiichiro; Doyama, Hisashi; Takeda, Yasuhito; Takemura, Kenichi; Yoshida, Naohiro; Kito, Yosuke; Asahina, Yasuhiko; Ito, Renma; Nakanishi, Hiroyuki; Hayashi, Tomoyuki; Inagaki, Shinji; Tominaga, Kei; Waseda, Yohei; Tsuji, Shigetsugu; Yamada, Shinya; Hino, Shoryoku; Okada, Toshihide

doi:10.1111/den.12211

Cited by 9 publications

(12 citation statements)

References 21 publications

(48 reference statements)

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“…When the hypopharyngeal observation was performed with the dedicated mouthpiece, examiners instructed patients to perform the Valsalva maneuver (▶ Supplementary Video 1 ). Conversely, when the observation was performed with a conventional mouthpiece, examiners instructed patients to vocalize, which is the current standard technique to improve hypopharynx visibility using a conventional mouthpiece [20,21]. During the observation, pictures of the oropharynx and the hypopharynx were taken for later evaluation by three external evaluators.…”

Section: Examiners and Pharyngeal Observationmentioning

confidence: 99%

Usefulness of a dedicated mouthpiece for the Valsalva maneuver to visualize the hypopharynx during transoral endoscopy

et al. 2020

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Background and study aims Patients with esophageal squamous cell carcinoma (SCC) are at high risk of developing second primary SCCs in the hypopharynx. However, such second primary tumors are difficult to observe because of lumen closure. The Valsalva maneuver using a dedicated mouthpiece is a promising technique to visualize the hypopharynx during transoral endoscopy. In the current study, we investigated the utility of this method. Patients and methods The current study was a randomized, controlled, crossover trial. Patients with esophageal SCC were randomly assigned first to undergo pharyngeal observation using the dedicated mouthpiece followed by observation using a conventional mouthpiece, or vice versa. The primary endpoint was complete visualization of the hypopharynx, which was assessed blindly by three external evaluators. Results A total of 68 pharyngeal examinations were analyzed – 34 with the dedicated mouthpiece and 34 with a conventional mouthpiece. Complete visualization was achieved in 68 % of the examinations (23/34) using the dedicated mouthpiece, whereas none of the examinations using the conventional mouthpiece achieved complete visualization of the hypopharynx. Observation scores of the oropharynx were not significantly different between both types of examination (P = 0.50). No serious adverse events (AEs) occurred. Conclusions Endoscopic view of the hypopharynx was markedly improved by the Valsalva maneuver using the dedicated mouthpiece, with no serious AEs. This procedure should be included in the endoscopic examinations for the patients with esophageal SCCs.

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Section: Examiners and Pharyngeal Observationmentioning

confidence: 99%

Usefulness of a dedicated mouthpiece for the Valsalva maneuver to visualize the hypopharynx during transoral endoscopy

et al. 2020

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“…Therefore, endoscopic examination for patients who are at high risk for developing HN cancer is usually conducted by transoral endoscopy. However, the lateral and anterior walls of the oropharynx, postcricoid area, and posterior wall of the hypopharynx are difficult to observe using transoral endoscopy. Advanced cancer can easily be missed in these regions even when NBI is used .…”

Section: Introductionmentioning

confidence: 99%

Transoral endoscopic examination of head and neck region

Hamada

Ishihara

Yamasaki

et al. 2018

Digestive Endoscopy

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Transoral endoscopy with narrow band imaging (NBI) is useful for early detection of head and neck (HN) cancer. However, the lateral and anterior walls of the oropharynx, postcricoid area, and posterior wall of the hypopharynx are difficult to observe using transoral endoscopy. Advanced cancers in these regions may be missed even when NBI is used. This report highlights a method of transoral endoscopic examination of the HN region. For observation of the oral cavity and oropharynx, it is important to observe these regions without using a mouthpiece. Wide opening of the mouth facilitates observation of the oral cavity and oropharynx. Moreover, visibility of the oropharynx, including the anterior wall, is dramatically improved, when the patient positions the tongue forward and says 'aaah.' This technique also facilitates observation of the dorsum of the tongue, which is difficult to observe from a tangential view when using a mouthpiece. To observe the hypopharynx, the Valsalva maneuver is very useful. Patient cooperation is important when observing the HN region thoroughly to gain clear endoscopic views. Narcotic drugs, such as pethidine hydrochloride, are ideal for conscious sedation and reduce the gag reflex while still allowing patient cooperation. From the oral cavity to the hypopharynx, including the lateral and anterior walls of the oropharynx, postcricoid area, and posterior wall of the hypopharynx, most of the HN region can be observed during routine examination using transoral endoscopy without any special devices.

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“…However, sedation disturbs patient vocalization and observation of the pyriform sinus and the uvula. Indeed, a previous study failed to demonstrate any benefit from use of benzodiazepines for observation of the pyriform sinus . Opioids are another option for UGIE, which can achieve conscious sedation .…”

Section: Introductionmentioning

confidence: 99%

“…[12][13][14][15] If cancers are detected at an early stage, implementation of minimally invasive treatment and better prognosis are expected. [16][17][18] Upper gastrointestinal endoscopy (UGIE) and narrow band imaging (NBI) has been reported to be useful for early detection of HNC, especially pharyngeal cancer (PC), [8][9][10]19,20 and it is currently considered the best modality for early detection of PC. For pharyngeal observation, patient cooperation is important because their vocalization can help to open the pyriform sinus and the space surrounding the uvula.…”

Section: Introductionmentioning

confidence: 99%

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Pethidine hydrochloride is a better sedation method for pharyngeal observation by transoral endoscopy compared with no sedation and midazolam

Yamasaki

Ishihara

Hanaoka

et al. 2016

Digestive Endoscopy

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Use of transoral endoscopy for pharyngeal examination: Cross‐sectional analysis

Abstract: Transoral endoscopic examination was possible in most patients for screening of the head and neck. However, results were poor in the pyriform sinuses, indicating that additional improvements of examination methods and instruments are needed to enhance screening accuracy.

Cited by 9 publications

References 21 publications

Usefulness of a dedicated mouthpiece for the Valsalva maneuver to visualize the hypopharynx during transoral endoscopy

Usefulness of a dedicated mouthpiece for the Valsalva maneuver to visualize the hypopharynx during transoral endoscopy

Transoral endoscopic examination of head and neck region

Pethidine hydrochloride is a better sedation method for pharyngeal observation by transoral endoscopy compared with no sedation and midazolam

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