Transnasal endoscopy with narrow-band imaging and Lugol staining to screen patients with head and neck cancer whose condition limits oral intubation with standard endoscope (with video).
BACKGROUND
Early detection of esophageal cancer in patients with head and neck cancers may alter treatment planning and improve survival. However, standard endoscopic screening is not feasible for some patients with tumor-related airway compromise or postirradiation trismus.


OBJECTIVE
To evaluate a novel, sequential approach by integrating ultrathin endoscopy with narrow-band imaging and Lugol chromoendoscopy.


METHODS
Cross-sectional study.


METHODS
Single center in Taiwan.


METHODS
Forty-four consecutive patients with transoral difficulty screened for synchronous or metachronous esophageal cancer.


METHODS
Sensitivity, specificity, and accuracy in the detection of mucosal high-grade neoplasia or invasive cancer.


RESULTS
Fifty-four endoscopic interpretations were obtained, and 11 mucosal high-grade neoplasia and 7 invasive cancers were confirmed by histology. The mean examination time was 19.4 minutes (range 7.9-35.2 minutes), and all patients tolerated the procedure well. Sensitivity, specificity, and accuracy (with 95% CI) were 55.6% (95% CI, 33.5%-75.6%), 97.2% (95% CI, 85.8%-99.3%), and 83.3% (95% CI, 71.2%-90.9%), respectively, for standard endoscopy; 88.9% (95% CI, 66.9%-96.6%), 97.2% (95% CI, 85.8%-99.3%), and 94.4% (95% CI, 84.9%-97.9%), respectively, with the adjunct of narrow-band imaging; and 88.9% (95% CI, 66.9%-96.6%), 72.2% (95% CI, 55.9%-84.1%), and 77.8% (95% CI, 64.9%-86.8%), respectively, with the adjunct of Lugol chromoendoscopy. When we integrated all interpretations on the basis of the sequential approach, the estimated probability of false-negative findings was 1.2% (95% CI, 0.1%-4.6%).


CONCLUSIONS
Inherent shortcomings of ultrathin endoscopy, such as its resolution, light source, and lack of magnification.


CONCLUSIONS
The use of ultrathin endoscopy in a sequential approach for multimodal detection is feasible in patients with transoral difficulty and substantially increases the detection rate of synchronous or metachronous neoplasms.
Lee
Yi-Chia
YC
Department of Internal Medicine, National Taiwan University Hospital, Division of Biostatistics, Taipei, Taiwan.
Wang
Cheng-Ping
CP
Chen
Chien-Chuan
CC
Chiu
Han-Mo
HM
Ko
Jenq-Yuh
JY
Lou
Pei-Jen
PJ
Yang
Tsung-Lin
TL
Huang
Hsin-Yi
HY
Wu
Ming-Shiang
MS
Lin
Jaw-Town
JT
Hsiu-Hsi Chen
Tony
T
Wang
Hsiu-Po
HP
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001003:Anal Canal; D004396:Coloring Agents; D003430:Cross-Sectional Studies; D016099:Endoscopy, Gastrointestinal / Q000379:methods*; D004938:Esophageal Neoplasms / Q000473:pathology*; D005260:Female; D006258:Head and Neck Neoplasms / Q000473:pathology*; D006801:Humans; D007454:Iodides; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D014741:Video Recording
D004396:Coloring Agents; D007454:Iodides; C010389:Lugol's solution