Clin Endosc.  2023 May;56(3):315-324. 10.5946/ce.2022.072.

Efficacy of endoscopy under general anesthesia for the detection of synchronous lesions in oro-hypopharyngeal cancer

• Ono Y
• Yao K
• Takaki Y
• Ishikawa S
• Imamura K
• Koga A
• Ohtsu K
• Kanemitsu T
• Miyaoka M
• Hisabe T
• Ueki T
• Ota A
• Tanabe H
• Haraoka S
• Nimura S
• Iwashita A
• Sato S
• Wakasaki R

• KMID: 2542459
• DOI: http://doi.org/10.5946/ce.2022.072

Abstract

Background/Aims
Image-enhanced endoscopy can detect superficial oro-hypopharyngeal squamous cell carcinoma; however, reliable endoscopy of the pharyngeal region is challenging. Endoscopy under general anesthesia during transoral surgery occasionally reveals multiple synchronous lesions that remained undetected on preoperative endoscopy. Therefore, we aimed to determine the lesion detection capability of endoscopy under general anesthesia for superficial oro-hypopharyngeal squamous cell carcinoma.
Methods
This retrospective study included 63 patients who underwent transoral surgery for superficial oropharyngeal squamous cell carcinoma between April 2005 and December 2020. The primary endpoint was to compare the lesion detection capabilities of preoperative endoscopy and endoscopy under general anesthesia. Other endpoints included the comparison of clinicopathological findings between lesions detected using preoperative endoscopy and those newly detected using endoscopy under general anesthesia.
Results
Fifty-eight patients (85 lesions) were analyzed. The mean number of lesions per patient detected was 1.17 for preoperative endoscopy and 1.47 for endoscopy under general anesthesia. Endoscopy under general anesthesia helped detect more lesions than preoperative endoscopy did (p<0.001). The lesions that were newly detected on endoscopy under general anesthesia were small and characterized by few changes in color and surface ruggedness.
Conclusions
Endoscopy under general anesthesia for superficial squamous cell carcinoma is helpful for detecting multiple synchronous lesions.

Keyword

Hypopharyngeal squamous cell carcinoma; Squamous cell carcinoma of the head and neck; Transoral surgery

Figure

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  Fig. 1. Endoscopic findings suggestive of squamous cell carcinoma. (A) A reddish, slightly rugged lesion showing increased vascular density on conventional white-light endoscopy (white arrows). (B) A whitish lesion with rough mucosa and no visible vascular pattern on conven­tional white-light endoscopy (black arrows). (C) A lesion with a well-demarcated brownish area on narrow-band imaging. (D) A lesion with an irregular microvascular pattern on magnified narrow-band imaging. (E) A lesion showing an iodine-unstained area on iodine staining. (F) A lesion showing a pink color sign on iodine staining.

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  Fig. 2. Endoscopic findings under general anesthesia of endoscopic submucosal dissection for superficial oro-hypopharyngeal squamous cell carcinoma. (A) Preoperative endoscopy using patient vocalization. Superficial pharyngeal squamous cell carcinoma (arrows) in the right pyriform sinus. (B) Endoscopy under general anesthesia. Superficial pharyngeal squamous cell carcinoma (arrows) in the right pyriform si­nus (iodine staining). (C) Subepithelial dissection was carried out with traction using curved and cupped forceps. (D) En bloc resection was achieved.

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  Fig. 3. Flow chart of lesions targeted by this study.

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