title: Hypopharyngeal perforation near-miss during transesophageal echocardiography.
abstract: OBJECTIVE
  The traditional blind passage of a transesophageal echocardiography probe transorally through the hypopharynx is considered safe. Yet, severe hypopharyngeal complications during transesophageal echocardiography at several institutions led the authors to investigate whether traditional probe passage results in a greater incidence of hypopharyngeal injuries when compared with probe passage under direct visualization.
  
  
  METHODS
  Randomized, prospective clinical study.
  
  
  METHODS
  In 159 consciously sedated adults referred for transesophageal echocardiography, the authors performed transesophageal echocardiography with concomitant transnasal videoendoscopic monitoring of the hypopharynx. Subjects were randomly assigned to receive traditional (blind) or experimental (optical) transesophageal echocardiography. The primary outcome measure was frequency of hypopharyngeal injuries (hypopharyngeal lacerations or hematomas), and the secondary outcome measure was number of hypopharyngeal contacts.
  
  
  RESULTS
  No perforation occurred with either technique. However, hypopharyngeal lacerations or hematomas occurred in 19 of 80 (23.8%) patients with the traditional technique (11 superficial lacerations of pyriform sinus, 1 laceration of pharynx, 12 arytenoid hematomas, 2 vocal fold hematomas, and 1 pyriform hematoma) and in 1 of 79 patients (1.3%) with the optical technique (superficial pyriform laceration) (P =.001). All traumatized patients underwent flexible laryngoscopy, but none required additional intervention. Respectively, hypopharyngeal contacts were more frequent with the traditional than with the optical technique at the pyriform sinus (70.0% vs. 10.1% [P =.001]), arytenoid (55.0% vs. 3.8% [P =.001]), and vocal fold (15.0% vs. 3.86% [P =.016]).
  
  
  CONCLUSIONS
  Optically guided trans-esophageal echocardiography results in significantly fewer hypopharyngeal injuries and fewer contacts than traditional, blind transesophageal echocardiography. The optically guided technique may result in decreased frequency of potentially significant complications and therefore in improved patient safety.
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Columbia University Medical Center, New York-Presbyterian Hospital, College of Physicians and Surgeons, Columbia University, New York, New York 10032, USA. jea10@columbia.edu
authors.forename: Jonathan E
authors.initials: JE
authors.lastname: Aviv
authors.forename: Marco R
authors.initials: MR
authors.lastname: Di Tullio
authors.forename: Shunichi
authors.initials: S
authors.lastname: Homma
authors.forename: Ian S
authors.initials: IS
authors.lastname: Storper
authors.forename: Anne
authors.initials: A
authors.lastname: Zschommler
authors.forename: Guoguang
authors.initials: G
authors.lastname: Ma
authors.forename: Eva
authors.initials: E
authors.lastname: Petkova
authors.forename: Mark
authors.initials: M
authors.lastname: Murphy
authors.forename: Rosemary
authors.initials: R
authors.lastname: Desloge
authors.forename: Gary
authors.initials: G
authors.lastname: Shaw
authors.forename: Stanley
authors.initials: S
authors.lastname: Benjamin
authors.forename: Steven
authors.initials: S
authors.lastname: Corwin
mesh_terms: D000328:Adult; D017548:Echocardiography, Transesophageal / Q000009:adverse effects*; D005260:Female; D006406:Hematoma / Q000473:pathology; D006801:Humans; D007013:Hypopharynx / Q000293:injuries* / Q000473:pathology; D007828:Laryngoscopy / Q000379:methods*; D008297:Male; D008875:Middle Aged; D010608:Pharyngeal Diseases / Q000175:diagnosis* / Q000473:pathology; D011446:Prospective Studies