Transnasal Esophagoscopy: A Viable Alternative to Conventional Procedures

In patients with chronic reflux, TNE is used for the detection and surveillance of Barrett’s esophagus (BE) to ensure that the disease has not become cancerous, said Dr. Aviv. Why use conscious [intravenous] sedation? he questioned. In patients with proven Barrett’s esophagus, it’s an endoscopic evaluation of the esophagus that is critical, so conventional endoscopy under sedation isn’t necessary.

Even though TNE may help to detect BE, physicians are still uncertain of what type of treatment these patients should receive, noted Timothy Anderson, MD, of the Department of Otolaryngology/Head and Neck Surgery at the Lahey Clinic Voice Center in Burlington, MA. We don’t know for sure yet if we can cut down on rates or esophageal cancer by treating patients with Barrett’s esophagus, he said. However, one recent study (Shaheen NJ et al. NEJM 2009;360:2277-88) found that radiofrequency ablation of BE resulted in a high rate of complete eradication of dysplasia and intestinal metaplasia and reduced risk of disease progression.

In a 2002 retrospective database and chart review of 17 patients with presumed head and neck cancer (Laryngoscope 2002; 112:2242-3), Dr. Postma and his colleagues found that TNE provided 100% accuracy in biopsy results and staging of the tumor when compared with standard panendoscopy. The researchers also demonstrated the use of TNE in stricture dilation and secondary tracheoesophageal puncture in head and neck cancer patients.

Another recent study found that TNE can distinguish between functionally or anatomically related dysphagia and newly growing tumors in the upper digestive tract in patients who had recently undergone treatment for head and neck cancer (Wang CP et al. Oral Oncol 2009;45:615-20).

In addition to assessing a variety of esophageal and extraesophageal conditions, TNE can be used to remove esophageal foreign bodies, said Dr. Anderson. The foreign body can frequently be diagnosed and managed entirely in the office with TNE, he noted. Small, flexible objects such as fish bones are the easiest objects to remove, he said, adding that he has also taken out toothpicks, bay leaves, string, and French fries.

Thinner and more specialized instruments placed through working channels will one day enable physicians to use TNE to perform a variety of other esophageal interventions, although such instruments currently are not available, said Dr. Postma.

In addition to removing foreign bodies and performing biopsies of the laryngopharynx and esophagus, and ballooning strictures in the esophagus and neopharynx, secondary tracheoesophageal punctures are also commonly performed, said Dr. Postma. Moreover, TNE endoscopes can also be used to deliver flexible lasers to lesions in the laryngopharynx and esophagus.