Oncologic Panendoscopy: Description of an Optimized Procedure Based on Our Experience

Introduction All patients with a new head and neck squamous cell carcinoma (HNSCC) undergo diagnostic panendoscopy as part of the screening for synchronous second primary tumors. It includes a pharyngolaryngoscopy (PLS), a tracheobronchoscopy and esophagoscopy, and a stomatoscopy. Rigid techniques are risky, with long learning curves. Objective We propose a precise description of the panendoscopy protocol. We include an optimization of the PLS technique that completes the flexible esophagoscopy when rigid esophagoscopy isn't performed. Methods The present retrospective observational study includes 122 consecutive patients with a new primary HNSCC who underwent traditional panendoscopy and the new PLS technique between January 2014 and December 2016. A two-step procedure using a Macintosh laryngoscope and a 30° telescope first exposes panoramically the larynx, the upper trachea, and the oropharynx; then, in a second step, the hypopharynx is exposed down to the upper esophageal sphincter. Broncho-esophagoscopy is performed with a rigid and flexible scope. Results In total, 6 (5%) patients presented synchronous tumors (3 in the esophagus, 2 in the oral cavity, and 1 in the larynx 1). Rigid endoscopy was complicated by 2 (1,6%) dental lesions, and had to be completed with a flexible scope in 38 (33%) cases for exposition reasons. The two-step PLS offered a wide-angle view of the larynx, upper trachea, and oro- and hypopharynx down to the sphincter of the upper esophagus. The procedure was easy, reliable, safe, repeatable, and effectively completed the flexible endoscopies. Conclusion Rigid esophagoscopy remains a difficult procedure. Two-step PLS combined with flexible broncho-esophagoscopy offers good optical control.

Case report of uncommon esophageal foreign body: goat’s eye

<p>Foreign bodies of upper aero digestive tract are commonly dealt by an otolaryngologist. We have seen a variety of foreign bodies of esophagus, varying from irritants to non irritants, sharp to big blunt objects which almost always require intervention. An elderly man presented to us with acute onset of dysphagia after ingesting meat. On flexible esophagoscopy, it was found to be an uncommon foreign body of the esophagus which is goat’s eye. We believe this is the first of its kind to be reported in the literature. He had consumed the whole eyeball with the belief that it would improve his vision. Even in today’s era such weird customs and practices prevail in many remote places. Health education should be advocated in target areas to bring about a change in the mindset of people. </p>

Esophageal foreign bodies in adults with different durations of time from ingestion to effective treatment

Objective This study was performed to identify the differences in clinical characteristics, operative methods, complications, and postoperative hospitalization stays for adults with esophageal foreign bodies with different durations of time from ingestion to effective treatment. Methods We retrospectively reviewed the medical records of 221 patients with a diagnosis of a foreign body in the esophagus, confirmed by rigid esophagoscopy, flexible esophagoscopy, or surgery. The differences between the two groups (Group A, ≤24 hours from ingestion to effective treatment; Group B, >24 hours from ingestion to effective treatment) were analyzed. Results Sharp foreign bodies comprised the majority of objects in the two groups, including jujube pits, bones (excluding fish bones), fish bones, dentures, and seafood shells. Foreign bodies located in the upper esophagus were more commonly observed in Group A than B. Significant differences were observed in the complication rate and length of postoperative hospitalization stays. Adults with esophageal foreign bodies had a high complication rate. Conclusions Rigid esophagoscopy can be used to remove sharp and bulky foreign bodies if more effective methods are unavailable. Effective treatment within 24 hours resulted in fewer complications and shorter postoperative hospitalization stays.

CLINICAL AND PARACLINICAL CHARACTERISTICS AND RESULTS FROM TREATMENT OF FOREIGN BODIES INGESTION

Background: Foreign bodies ingestion is a emergency in otology, knowledge of people about foreign bodies ingestion is not enough. Objective: To study the clinical characteristics, paraclinical characteristics and results of treatment from foreign bodies ingestion in Hue Central Hospital and Hue University Hospital. Methods and patiens: A cross descriptive and prospective study over the period from 6/2014 to 5/2016, total are 137 patients come to be diagnosised and treatmented. Results: the average age is 35 years old. Gender: male (51.8%) and women (48.2%). Adults (84.7%) having more than children (15.3%). Age group from 16-30 years is highest (32.8%). There are 95.7% of organic foreign bodies, 4.3% are inorganic foreign bodies. There are 90.5% of patients on diagnosis and treatment in stages less inflammation, arthritis 8.0% in the period and 1.5% in the period complications. Foreign body in the throat problems (73.7%), esophageal foreign bodies (26.3%). Pick up directly foreign bodies 54%, indirectly by the mirror 11.7% and endoscopy 8%, rigid esophagoscopy is 17.5%, flexible esophagoscopy is 7.3%, cervicotomy is 1.5%. Conclusion: Practing direction with in the oropharynx foreign body, using the larynx mirror or endoscopy with in the laryngopharynx for the esophagus foreign bodies, rigid esophagoscopy is better. Key words: Foreign bodies ingestion

Upper gastro intestinal foreign bodies in pediatrics patients

Aim: Analyzeexperience with presentation, diagnosis and management of accidental ingested upper digestive tract foreign bodies in children. Materials: A prospective study of 60 pediatric patients from July 2009 to July 2014 with history of accidental ingested upper gastro intestinal foreign bodies. All patients were studied for age, gender, complaints, duration, site of impaction, type and complications. Radiological investigations were taken according to the case. Direct laryngoscopy and Magill forceps or flexible esophagoscopy has been used for retrieval of foreign bodies. Result: Sixty cases were analyzed age between 6 months to 13 years. Male 42 and female 18. Age group 6 months to 6 years constitutes 85%. Thirty six (60%) patients arrived to hospital within 24 hours. Difficultly in swallowing (70%) was the most frequent symptom. Most foreign bodies were coin in the upper esophagus (70%). Preexisting esophageal disease was present in 20%. Out of 60 patients twenty four (40%) FB retrieved using Magill forceps and rest with Flexible esophagoscopy (60%). Foreign bodies were successfully removed without major complication in all cases. Mucosal erosions were seen in four patients after extraction. All patients except 4 were discharged within 24 hours after the procedure. Conclusion: Children between 6 month to 6 years is the commonest age group affected. Magill forceps with the aid of a direct laryngoscope is a safe and effective method for proximal esophageal foreign body removal. But flexible esophagoscopy remains the safest method of upper digestive tract foreign body extraction.