Use of transnasal endoscopy for screening of esophageal squamous cell carcinoma in high-risk patients: Yield rate, completion rate, and safety

BackgroundPatients with head and neck squamous cell carcinoma are at high risk for synchronous and/or metachronous esophageal cancer. The present study aimed to evaluate the feasibility and safety of unsedated transnasal endoscopy (TNE) for screening these high-risk patients. Patients and MethodsConsecutive high-risk patients including patients with suspicious or diagnosed head and neck cancer or patients with alarming symptoms received screening TNE. All endoscopic procedures, including sequential conventional white-light, narrow-band imaging, and Lugol chromoendoscopy, were done without sedation. All suspicious lesions in the esophagus were biopsied for histological evaluation. The completion rate, procedure time, and significant adverse events of all endoscopic procedures were recorded and analyzed. ResultsFrom May 2007 to August 2011, a total of 500 TNE were carried out in 441 high-risk patients. Among them, 294 patients (66.7%) had diagnosed head and neck squamous cellcarcinoma, and most were hypopharyngeal cancer (n=186). Esophageal squamous cell carcinomas and high-grade intraepithelial neoplasms were detected in 10.1% and 7.3%, respectively, of the cases. Completion rate of TNE in head and neck cancer was 96.7%; tumor obstruction and stenosis of anastomosis site were the main reasons for incomplete procedures. Mean duration of the endoscopic procedure was 14.6min. One patient had post-endoscopic epistaxis while another patient had post-biopsy hemoptysis, both of whom were treated conservatively. No procedure-related mortality or significant morbidity occurred. ConclusionUnsedated TNE is safe and feasible for screening synchronous or metachronous esophageal neoplasms in high-risk patients, especially those with head and neck cancer.