title: Prospective multi-institutional transnasal esophagoscopy: Predictors of a change in management.
abstract: To evaluate clinical indications and endoscopic findings for patients undergoing transnasal esophagoscopy (TNE).
  
  
  
  Prospective, multi-institutional, observational cohort study at four tertiary centers.
  
  
  
  Demographics, reflux finding score, reflux symptom index, Eating Assessment Tool (EAT-10) scores, clinical indications, and endoscopic findings were compared among patients whose TNE findings resulted in a changes in management (FCIM), defined as a referral, new medication, or surgery recommendation.
  
  
  
  Of the 329 patients who were enrolled nine (3%) were unable to complete the exam. In an adjusted regression model, male gender and elevated body mass index were significantly predictive of a positive TNE (P =.013-.045); 51% (n = 162/319) had TNE with FCIM. Common FCIM were esophageal stricture (7.5%), irregular Z-line (27.4%), reflux esophagitis (12.8%), and infectious esophagitis (6.3%) (P <.001-.010). Overall, the average EAT-10 was higher for patients with FCIM (9.7 vs. 5.4) than in those without it (P =.014). Patients with a history of head and neck cancer (HNCA) had FCIM 64% of the time, which rose to 81% if they had both HNCA and dysphagia.
  
  
  
  In treatment-seeking patients TNE is predictive of a change in management in males and obese patients. In patients with HNCA and dysphagia, TNE is likely to yield findings that cause a change in management.
  
  
  
  2b. Laryngoscope, 126:2667-2671, 2016.
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, University of Cincinnati College of Medicine, Cincinnati, Ohio, U.S.A.
authors.forename: Rebecca J
authors.initials: RJ
authors.lastname: Howell
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery and Center for Voice Airway and Swallowing, Georgia Regents University, Augusta, Georgia, U.S.A.
authors.forename: Mariah B
authors.initials: MB
authors.lastname: Pate
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, University of Cincinnati College of Medicine, and Divisions of Otolaryngology-Head and Neck Surgery and Pulmonary Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, U.S.A.
authors.forename: Stacey L
authors.initials: SL
authors.lastname: Ishman
authors.affiliation: New York Eye and Ear Infirmary of Mount Sinai, New York, New York, U.S.A.
authors.forename: Tova F
authors.initials: TF
authors.lastname: Isseroff
authors.affiliation: Lakeshore Professional Voice, St. Clair Shores, Michigan, U.S.A.
authors.forename: Adam D
authors.initials: AD
authors.lastname: Rubin
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania, U.S.A.
authors.forename: Ahmed M
authors.initials: AM
authors.lastname: Soliman
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery and Center for Voice Airway and Swallowing, Georgia Regents University, Augusta, Georgia, U.S.A.
authors.forename: Gregory N
authors.initials: GN
authors.lastname: Postma
authors.affiliation: Voice and Swallowing Institute, Department of Otolaryngology-Head and Neck Surgery, Columbia University Medical Center, New York, New York, U.S.A.
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Pitman
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001471:Barrett Esophagus / Q000150:complications / Q000175:diagnosis; D015992:Body Mass Index; D003680:Deglutition Disorders / Q000209:etiology / Q000628:therapy*; D004941:Esophagitis / Q000150:complications / Q000175:diagnosis / Q000628:therapy; D004945:Esophagoscopy / Q000379:methods; D005260:Female; D005764:Gastroesophageal Reflux / Q000150:complications / Q000175:diagnosis / Q000628:therapy; D006801:Humans; D008297:Male; D008875:Middle Aged; D009765:Obesity; D011446:Prospective Studies; D012044:Regression Analysis; D012737:Sex Factors; D055815:Young Adult
keywords: Eating Assessment Tool; Transnasal esophagoscopy; esophageal pathology; head and neck cancer; odynophagia