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

Area of Science:

• Otolaryngology
• Gastroenterology
• Oncology

Background:

• Diagnostic panendoscopy is crucial for screening head and neck squamous cell carcinoma (HNSCC) patients for synchronous second primary tumors.
• Traditional rigid endoscopy techniques carry risks and have steep learning curves.

Purpose of the Study:

• To describe a precise panendoscopy protocol.
• To present an optimized pharyngolaryngoscopy (PLS) technique that complements flexible esophagoscopy when rigid esophagoscopy is not performed.

Main Methods:

• A retrospective observational study of 122 HNSCC patients undergoing traditional panendoscopy and the new two-step PLS technique.
• The two-step PLS involves a Macintosh laryngoscope and 30° telescope for panoramic views of the larynx, upper trachea, oropharynx, and hypopharynx down to the upper esophageal sphincter.
• Broncho-esophagoscopy was performed using rigid and flexible scopes.

Main Results:

• Six patients (5%) had synchronous tumors (3 esophageal, 2 oral cavity, 1 laryngeal).
• Rigid endoscopy resulted in 2 dental lesions (1.6%) and required flexible scope completion in 33% of cases due to exposure limitations.
• The two-step PLS provided a wide-angle, safe, repeatable, and effective view, completing flexible endoscopies.

Conclusions:

• Rigid esophagoscopy is technically challenging.
• The described two-step PLS combined with flexible broncho-esophagoscopy provides excellent optical control for HNSCC screening.