Objective To assess the efficacy and safety of flexible vs. rigid esophagoscopy in an academic training setting. Methods A retrospective medical record review was performed on all adult patients undergoing esophagoscopy in a tertiary care academic training center from 2002 to 2007. Results A total of 546 procedures were performed using both flexible (n=276) and rigid (n=270) endoscopes. 7 esophageal perforations occurred, all in association with rigid endoscopy and all in patients with a history of head and neck cancer. Perforation occurred in 3 patients while searching for a metastatic or synchronous tumor, in 3 patients undergoing dilation or tracheoesophageal puncture, and in 1 patient prior to biopsy of a known esophageal mass. There were no deaths. Esophageal perforation rates were associated with attending level of experience. In 370 patients undergoing esophagoscopy for an unknown primary workup or as part of panendoscopy for the initial evaluation of a head and neck cancer, no synchronous esophageal cancers were found. Conclusions The 2.6% esophageal perforation rate observed in this study is higher than that typically reported for rigid esophagoscopy. All injuries occured in patients with a history of upper aerodigestive tract cancer. The safety of rigid esophagoscopy was commensurate with the experience of the attending physician. When performed as part of routine panendoscopy, no synchronous esophageal tumors were found, questioning the value of esophagoscopy in this setting. As fiberoptic techniques are associated with lower complication rates, these should be employed until the novice operator attains some degree of proficiency in esophagoscopy.
Iatrogenic esophageal perforation in patients with head and neck cancer: Evaluation of the SEER-Medicare database