Structured oropharynx, hypopharynx and larynx assessment during routine esophagogastroduodenoscopy improves detection of pre- and early cancerous lesions: a multicenter, comparative study

Abstract

Background and study aims A structured assessment of the oropharynx, hypopharynx and larynx (OHL) may improve the diagnostic yield for the detection of precancerous and early cancerous lesions (PECLs) during routine esophagogastroduodenoscopy (EGD). Thus, we aimed to compare routine EGDs ± structured OHL assessment (SOHLA), including photo documentation with regard to the detection of PECLs. Patients and methods Consecutive patients with elective EGD were arbitrarily allocated to endoscopy lists with or without SOHLA. All detected OHL abnormalities were assessed by an otolaryngologist-head & neck surgeon (ORL-HNS) and the frequency of PECLS detected during SOHLA vs. standard cohort compared. Results Data from 1000 EGDs with and 1000 EGDs without SOHLA were analyzed. SOHLA was successful in 93.3 % of patients, with a median assessment time of 45 seconds (interquartile range: 40-50). SOHLA identified 46 potential PECLs, including two benign subepithelial lesions (4.6 %, 95 % CI: 3.4-6.1) while without SOHLA, no malignant and only one benign lesion was found ( P < 0.05). ORL-HNS imaging review classified 23 lesions (2.3 %, 95 % CI: 1.5-3.4) as concerning and ORL-HNS clinic assessment was arranged. This identified six PECLs (0.6 %, 95 % CI: 0.2-1.3) including two pharyngeal squamous cell lesions (0.2 %) demonstrating high-grade dysplasia and carcinoma in situ (CIS) and four premalignant glottic lesions (0.4 %) demonstrating low-grade dysplasia and CIS. Conclusion In the routine setting of a gastrointestinal endoscopy practice precancerous and early cancerous lesions of the oropharynx, hypopharynx, and larynx are rare (< 1 %) but can be detected with a structured assessment of this region during routine upper gastrointestinal endoscopy.

Fig. 1

Imaging documentation during structured oropharynx, hypopharynx and larynx assessment. a Palate. b Posterior oropharynx. c Larynx. d, e Left and right pyriform fossa.

Fig. 2

Flow diagram of patients in the SOHLA and non-SOHLA cohort. SOHLA, structured oropharynx, hypopharynx and larynx assessment; EGD, esophagogastroduodenoscopy; OHL, oropharynx, hypopharynx and larynx; ORL-HNS, otolaryngologist-head&neck surgeon; ENT, ear, nose and throat specialist; SEL, subepithelial lesion; CT, computed tomography; DNA, did not attend; PECLs, precancerous or early cancerous lesions.

Fig. 3

Asymmetric posterior oropharynx subepithelial lesions correlated with axial computed tomography image. a, b Right-sided anterior osteophyte. c, d Prominent left-sided medialized carotid artery.

Fig. 4 a

Leukoplakia on the left vocal cord. b, c SCC in situ posterior oropharynx in high-definition white light and narrow-band imaging. d Benign squamous papilloma posterior oropharynx.

Fig. 5

Procedure report image of the single abnormality identified in the non-OHL assessment cohort demonstrating a torus palatinus: a benign bony exostosis arising in the midline of the hard palate.