The value of flexible endoscopy with Narrow Band Imaging for the evaluation of recurrence of laryngeal and hypopharyngeal tumours after radiotherapy

Background: The dia­gnosis of recurrent upper aerodigestive tumours is difficult, especially in the case of previous curative radiotherapy (RT) or chemoradiotherapy (CRT). Progress in the dia­gnostics of head and neck cancer came with the development of optical endoscopic imaging methods. The aim of this study was to analyse the benefits of flexible Narrow Band Imaging (NBI) in the visualization of suspected recurrence of malignancy in patients after curative RT (CRT). Methods: A total of 58 examined patients in follow-up after curative RT or CRT for laryngeal and hypopharyngeal squamous cell carcinoma were enrolled in the study. All patients underwent transnasal flexible endoscopy in conventional white light and NBI in local anaesthesia. Changes in microvascular architecture (intraepithelial papillary capillary loops – IPCL) have been classified according to Ni. IPCL I–III were considered to be non-suspicious, and therefore no histopathological examination was indicated. IV and V type findings were verified using HDTV NBI intraoperatively with bio­psy sampling and subsequent histopathological correlation was performed. Results: Transnasal videoendoscopic examination with NBI revealed a suspicious finding (IPCL type IV and V) in 23/58 (39.7%) patients, non-suspicious finding (IPCL I–III) in 35/58 (60.3%). Histopathological examination verified the positive finding (precancerous or malignant changes) in 12/23 (52.2%) and negative finding in 11/23 (47.8%) cases. The sensitivity, specificity, positive and negative predictive value of flexible NBI endoscopy were 100%, 76.1%, 52.2% and 100% respectively. According to the Kappa index (K = 0.568), we proved a moderate concordance between flexible NBI endoscopy and histopathological results. Conclusions: Transnasal flexible endoscopy with NBI in outpatient settings contributes to an early detection of pathological changes also in post-radiation altered mucosa of the larynx and hypopharynx, while a correct interpretation of in NBI findings is required to reduce the incidence of false positive results. Keywords: squamous cell carcinoma – Larynx – radiotherapy – narrow band imaging – Ni classification – hypopharynx

Mathematical Model Represents the Effect of Flexible Endoscopy on Suspension Fluid Flow

In this manuscript, peristaltic transport induced by a sinusoidal traveling wave in the case for a viscous incompressible Newtonian fluid mixed with rigid spherical particles in the presence of a flexible inner tube, where the inner tube is also moving with a sinusoidal traveling wave of moderate amplitude is studied. The governing equations of the mixture (fluid-particle suspension) are written in two-dimensional cylindrical coordinates. The long-wavelength approximation is used to simplify the system of equations (d<<1). The velocities distribution for both fluid and particles are obtained and evaluated numerically with discussion for special cases. The flow rate, pressure drop, friction forces and shear stress at the outer and inner walls of tubes are derived and represented graphically. In the urinary system, peristalsis is due to involuntary muscular contractions of the ureter wall which drives urine from the kidneys to the bladder through the ureters. A mathematical analysis of peristaltic flow with application to the ureter in presence of flexible endoscopy (Peristaltic Endoscope) is taken as a real application in this study. Finally, conclusions of the research and recommendations for future work are discussed. The results obtained may be relevant to the transport of other physiological fluids and industrial applications in which peristaltic pumping is used.

Early detection of laryngeal cleft in infants by novel technique of flexible endoscopy with sustained pharyngeal inflation

Objective: Report a novel technique of flexible endoscopy (FE) with noninvasive ventilation (NIV) and sustained pharyngeal inflation (FE-NIV-SPI) in assessing aeroesophageal tracts (AET) to facilitate early detect laryngeal clefts (LC). Methods: Medical charts and FE videos of the children who were diagnosed as LC in a tertiary care hospital between 2000 and 2020 were retrospectively reviewed and analyzed. FE-NIV-SPI technique was applied for all the reviewed children. Results: Of all the FE videos reviewed, twelve infants with laryngeal clefts were collected. This equates to a prevalence of 0.28% in all the children underwent FE at our institution. Their mean age was 5.0 ± 4.9 month-old and the mean body weight was 4.7 ± 2.3 kg. Nine (75%) infants were referred in without LC diagnosis, which was missed by 11 prior bronchoscopy and 5 computer tomography exams. With FE-NIV-SPI, the pharyngolaryngeal space could be pneumatically expanded and allowed detailed assessment. All LC types and coexisted AET lesions were visualized at the first FE-NIV-SPI examination with a mean time of 4.2 ± 0.9 minutes. They were eight type I, two type II and one type III. Ten (83.3%) infants coexisted airway malacia. Conclusion: Routinely using the FE-NIV-SPI technique can help detect the LC defect and associated AET lesions at the first assessment.

Bariatric Surgery—from the Non-surgical Approach to the Post-Surgery Individual Care: Role of Endoscopy in Bariatric Therapy

Obesity is the underlying constant for the development of the most common modern diseases such as insulin resistance, high blood pressure, lipid metabolism disorders, non-alcoholic steatohepatitis (fatty liver), joint problems and various malignancies. The role of endoscopic diagnostic and therapy in obese patients is highlighted in this chapter. In this chapter all devices and methods used in flexible endoscopy for diagnostic and treatment in obese patients are introduced. Role of endoscopy is presented in three parts: in preoperative setting, in post-operative complication management and instead of surgery as endoscopic bariatric therapy. If possible presentation of the effectiveness is compiled with study data. Finally, the interaction between endoscopy and surgery in the treatment of obesity is complex, essential and promising. Endoscopy is indispensable in preoperative preparation, as a primary therapeutic approach, and also in the detection and treatment of acute complications and long-term complications of obesity surgery.

Flexible endoscopy with noninvasive ventilation assesses and manages infants with severe bronchopulmonary dysplasia

Objectives Flexible endoscopy (FE) assessed the whole approachable aeroesophageal (AE) tracks and changes of management in infants with severe bronchopulmonary dysplasia (sBPD). Methods A 10 years (2011-2020) retrospective study of sBPD infants who had FE with and without artificial airway in AE tracks. FE with noninvasive ventilation (FE-NIV) of pharyngeal oxygen with nose-close and abdomen-compression was supported. Data of found pathologies, changes of consequent management and therapeutic interventions were collected and analyzed. Results Total 42 infants enrolled. Two scopes of 1.8mm and 2.6mm were used. FE revealed 129 AE pathologies in 38 (90.5%) infants. Twenty-eight (66.7%) infants detected more than one lesion. In 35 (83.3%) infants with 111 airway lesions, bronchial granulations (28, 25.2%), tracheomalacia (18, 16.2%) and bronchial granulations (15, 13.5%) were the leadings. Fifteen (35.7%) infants had 18 esophageal lesions. No significant FE-NIV complication noted. FE findings resulted consequent changes of management in all 38 infants. Thirty-six (85.7%) infants involved respiratory care of pressure titrations (29, 45.3%), shorten suctioning depth (17, 26.6%), changed endotracheal or tracheostomy tube depth (10, 15.6%) and extubation (8, 12.5%). Twenty-one (50%) infants had 50 medication changes included add steroids, anti-reflux medicine, antibiotics and stop antibiotics. Eighteen (42.8%) infants had received 37 therapeutic FE-NIV procedures which included 14 balloon dilatation, 13 laser-plasty and 10 stent implantations. Seven (16.7%) infants had surgeries included 4 tracheostomies and 3 fundoplications. Conclusion FE-NIV can be a safe and valuable modality for direct visual assessment of AE pathologies which contributed subsequent changes of clinical management in sBPD infants.

The application of rigid and flexible mediastinoscopy in esophagectomy: our experience and a new technology

Background To avoid the inconvenience of triangulation among various rigid operating instruments in mediastinoscopy-assisted esophagectomy, we invented a new technique: used a flexible endoscope to mobilize thoracic esophagus and dissected mediastinal lymph nodes through the left cervical incision. This technology has not been reported so far. In this study, we introduce our long-term experience and demonstrate this new technique. Methods Twenty-nine patients with early esophageal cancer underwent mediastinoscopy-assisted esophagectomy in our hospital from June 2018 to September 2020. Among them, 12 patients used flexible mediastinoscopy, and 17 patients used conventional rigid mediastinoscopy and instruments to observe their therapeutic effect. Results There were no significant differences between the two groups in gender, average age, body mass index, incidence of adverse reactions, bleeding volume, and postoperative hospital stay. The operation time of flexible mediastinoscopy group was significantly shorter than that of rigid mediastinoscopy group (192.9 ± 13.0 vs 246.8 ± 6.9 min, p < 0.01). The number of lymph nodes removed by flexible endoscopy was significantly more than that of rigid endoscopy (8.5 ± 0.6 vs 6.0 ± 0.3, P < 0.01). Postoperative follow-up was completed for all patients, and the average follow-up time was 11.6 ± 7.2 months. During the follow-up period, no recurrence or death was observed. Conclusions Mediastinoscopy-assisted esophagectomy is an effective way to treat early esophageal cancer. The application of flexible mediastinoscopy provides more convenience and better stability. It can facilitate the operation of the surgeon and lymph node dissection, which proved to be a feasible technology.

Flexible endoscopy versus direct laryngoscopy for localising impacted pharyngeal foreign bodies in emergency department: A randomised cross-over manikin pilot study

Background: Direct laryngoscopy is often poorly tolerated in patients with foreign body ingestion. The use of flexible endoscopes, which are reported to be better tolerated, was described. However, studies on endoscopy usage by emergency physicians are lacking. Objective: This study evaluates whether using a bronchoscope is as effective as the direct laryngoscopy for localising pharyngeal foreign bodies by emergency physicians. Methods: This was a randomised cross-over manikin study conducted on 32 emergency physicians. Four foreign bodies were placed at the oropharynx, vallecula, arytenoid and post-cricoid area of a manikin. Participants, being randomised into two groups, examined the pharynx with a bronchoscope and a direct laryngoscope in designated orders. The primary outcome was the complete visualisation rate defined as visualising all the four foreign bodies within the time limit. Secondary outcomes included participants-rated difficulty scores, device preferences, the time needed for complete visualisation and cumulative success rates. Results: Complete visualisation rate was significantly higher using the bronchoscope (93.8%) than the direct laryngoscope (62.5%) p = 0.02. The overall difficulty score was lower using the bronchoscope (median 4, interquartile range: 3–5) than the direct laryngoscope (median 6, interquartile range: 5–8), p < 0.001. The bronchoscope was the preferred method for overall examination (71.9%) over the direct laryngoscope (28.1%), p = 0.001. There were no significant differences in times needed for complete examination for the bronchoscope (median 73.6 s, interquartile range: 54.7–97.7 s) and the direct laryngoscope (median 82.2 s, interquartile range: 40.1–120 s), p = 0.9, and cumulative success rates, p = 0.081. Conclusion: The bronchoscope was associated with an increased complete visualisation rate and was the easier and preferred method for pharyngeal examination.