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Hindi Research Article
Observation of the Pharynx to the Cervical Esophagus Using Trans-nasal Endoscopy with Image-enhanced Endoscopy for Early Detection of Head and Neck Cancers
Kenro Kawada1*, Takuya Okada1, Taro Sugimoto2, Kazuya Yamaguchi1, Yuudai Kawamura1, Toshihiro Matsui1, Masafumi Okuda1, Taichi Ogo1, Yuuichiro Kume1, Andres Mora1, Akihiro Hoshino1, Yutaka Tokairin1, Yasuaki Nakajima1, Ryuhei Okada2, Yusuke Kiyokawa2, Fuminori Nomura2, Yosuke Ariizumi2, Takahiro Asakage2, Takashi Ito3 and Tatsuyuki Kawano41Department of Gastrointestinal Surgery, Tokyo Medical and Dental University, Tokyo, Japan
2Department of Head and Neck surgery, Tokyo Medical and Dental University, Tokyo, Japan
3Department of Human Pathology, Tokyo Medical and Dental University, Tokyo, Japan
4Department of Surgery, Soka Municipal hospital, Saitama, Japan
- Corresponding Author:
- Kawada K
Department of Gastrointestinal Surgery
Tokyo Medical and Dental University, Tokyo, Japan
Tel: +81-3-5803-5254
Fax: +81-3-3817-4126
E-mail: kawada.srg1@tmd.ac.jp
Received Date: August 18, 2017; Accepted Date: August 29, 2017; Published Date: August 31, 2017
Citation: Kawada K, Okada T, Sugimoto T, Yamaguchi K, Kawamura Y, et al. (2017) Observation of the Pharynx to the Cervical Esophagus Using Trans-nasal Endoscopy with Image-enhanced Endoscopy for Early Detection of Head and Neck Cancers. J Gastrointest Dig Syst 7:522. doi:10.4172/2161-069X.1000522
Copyright: © 2017 Kawada K, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Abstract
Introduction: We started endoscopic treatment for superficial pharyngeal cancer in 1996, and thus far, 97 lesions of 77 cases of superficial head and neck cancer have been detected using trans-oral endoscopy. However, some areas are difficult to observe with trans-oral endoscopy because of the gag reflex. We have therefore applied transnasal endoscopy for observing of the pharynx to the cervical esophagus.
Methods: To avoid overlooking cancers located at the floor of the mouth, soft palate and uvula, we first observe the oral cavity. After administering local anesthesia to the nose without sedation, the endoscope is inserted through the nose. When the tip of the endoscope reaches caudal to the uvula, the patient opens his or her mouth wide, sticks the tongue forward as far as possible and makes a makes a vocalization like “ayyy”. The endoscopist then makes the endoscope take a U-turn and observes the oropharynx, particularly radix linguae. To examine the hypopharynx and the orifice of the esophagus, the patient is asked to blow hard and puff their cheeks while the mouth remains closed. This approach provides a much better view of the orifice of the esophagus than is possible with trans-oral endoscopy with deep sedation.
Results: In this study, we detected 22 superficial cancers of the oral cavity. Previous efforts to detect such cancers using trans-oral endoscopy have failed. In addition, we were never able to detect early cancers located at base of tongue in the past, but since implementing the intra-oropharyngeal U-turn method, we have detected more than 10 cases. We were also never able to detect early cancers located at the pharyngoesophageal junction in the past, but since implementing the modified Valsalva maneuver, we have detected more than 20 cases. Between 2008 and 2016, a total of 164 cases of 227 lesions of superficial head and neck cancer were detected by trans-nasal endoscopy, which is more than twice as many as were detected with conventional screening. Mucosal redness, white deposits or loss of a normal vascular pattern and proliferation of vascular pattern such as small dots or salmon roe with a close-up view of it are important characteristics to diagnose superficial pharyngeal cancer. Moreover, a brownish area using image-enhanced endoscopy is useful for early diagnosis. With adequate extension of the pharyngeal mucosa using the Valsalva maneuver, observing the protruded areas should prove useful for diagnosing the depth of invasion.
Conclusions: Observing the pharynx to the cervical esophagus using trans-nasal endoscopy with imageenhanced endoscopy is useful for early detection of head and neck cancers.
