phenylephrine-hydrochloride and Esophageal-Diseases

Transnasal esophagoscopy is the most significant new development in laryngology/bronchoesophagology in recent years. This paper is designed to review the most important articles involving transnasal esophagoscopy over the past year.. Transnasal esophagoscopy is safe, effective, easy to learn, and significantly alters the management of a large number of individuals seen in otolaryngology practice.. Transnasal esophagoscopy has a major role in otolaryngology and gastroenterology practice and will enable the endoscopist to provide better quality of care to patients in a more cost-effective and safer manner.

Topics: Esophageal Diseases; Esophagoscopy; Humans; Nose

Unsedated upper endoscopy is an attractive alternative to conventional sedated endoscopy because it can reduce the cost, complications, and recovery time of the procedure. However, it has not gained widespread acceptance in the United States. A prototype 4-mm-diameter video esophagoscope is available. Our aims were to compare unsedated esophagoscopy using this 4-mm esophagoscope with conventional sedated endoscopy with regard to diagnostic accuracy and patient tolerance, to determine the optimal intubation route (transnasal vs. transoral), and to identify the predictors of tolerance of unsedated endoscopy.. Outpatients presenting for conventional endoscopy were randomized to undergo unsedated esophagoscopy by either the transnasal or the transoral route, followed by conventional endoscopy. The diagnostic findings, optical quality, and patient tolerance scores were assessed.. A total of 137 patients were approached and 90 (65.6 %) were randomized to undergo esophagoscopy by the transnasal route (n = 44) or by the transoral route (n = 46) before undergoing conventional esophagoscopy. Patient tolerance of unsedated esophagoscopy was comparable to that of conventional endoscopy. The transnasal route was better tolerated than the transoral route, except with respect to pain, and 93.2 % in transnasal group and 91.3 % in transoral group were willing to have the procedure again. The diagnostic accuracy of endoscopy using the 4-mm video endoscope was similar to that of standard endoscopy. Patients who tolerated the procedure well had lower preprocedure anxiety scores (29 vs. 42.5, P = 0.021) and a higher body mass index (31.5 kg/m2 vs. 28 kg/m2, P = 0.029) than the other patients.. Unsedated esophagoscopy with a 4-mm esophagoscope was well tolerated and has a level of diagnostic accuracy comparable to that of conventional endoscopy. Factors associated with good tolerance of unsedated esophagoscopy were low anxiety levels, high body mass index, and use of the transnasal route. Unsedated endoscopy may be offered to a selected group of patients based on these criteria.

Topics: Adult; Aged; Conscious Sedation; Equipment Design; Esophageal Diseases; Esophagoscopes; Esophagoscopy; Female; Fiber Optic Technology; Humans; Male; Middle Aged; Mouth; Nose; Outpatients; Patient Satisfaction; Prospective Studies; Reproducibility of Results; Surveys and Questionnaires; Video Recording

Otolaryngologists implement transnasal esophagoscopy (TNE) to assess esophageal pathology. Previous studies using TNE are largely retrospective and deal with select patient populations. The prevalence of esophageal pathology in patients presenting with throat symptoms to an otolaryngology voice center is presently unknown.. To assess the prevalence of esophageal pathology in this population and determine the interobserver variability of the findings reviewed by an otolaryngologist and a gastroenterologist.. A prospective study.. This study was conducted in a laryngology/voice subspecialty clinic.. Fifty patients with throat symptoms presenting to the voice center were asked prospectively to undergo TNE. The findings were videotaped and reviewed by an otolaryngologist and a gastroenterologist blinded to the patients' presenting complaint.. Hoarseness was the most common presenting symptom (68%). According to the gastroenterologist, the prevalence of esophageal findings was: z-line irregularity suspicious for Barrett esophagus (12%), esophagitis (10%), hiatal hernia (32%), and esophageal stricture (10%). The percent agreement for a normal study was 72 percent. The percent agreement for various pathological findings were as follows: Barrett esophagus 86 percent, esophagitis 88 percent, hiatal hernia 76 percent, and esophageal stricture 96 percent. For an abnormal study, the percent agreement was 80 percent.. Esophageal abnormalities are common in patients presenting to a voice subspecialty clinic.

Topics: Adult; Confidence Intervals; Esophageal Diseases; Esophagoscopy; Female; Humans; Male; Middle Aged; Nose; Prevalence; Prospective Studies; Videotape Recording

KEYPOINTS: Transnasal flexible laryngo-oesophagoscopy (TNFLO) is a safe and well-tolerated procedure that may be performed in a procedure room in the outpatient or day-case/main theatre setting. It requires a local anaesthetic and no sedation. It may be used to histologically diagnose or exclude pathology from the nose to the gastro-oesophageal junction. It provides a "one stop" diagnosis service, reducing diagnostic delays, the need for endoscopy under general anaesthesia, barium swallows and follow-up outpatient appointments. Therapeutic procedures such as vocal cord medialization, endolaryngeal laser surgery, insertion of speech prostheses and foreign body removal may be performed without general anaesthesia.

Topics: Ambulatory Care; Anesthetics, Local; Deglutition Disorders; Esophageal Diseases; Esophagoscopes; Esophagoscopy; Esophagus; Fiber Optic Technology; Foreign Bodies; Head and Neck Neoplasms; Humans; Laryngoscopes; Laryngoscopy; Neoplasm Recurrence, Local; Nose; Pharyngeal Diseases; Pliability; Posture; Prospective Studies; Recovery of Function; Vocal Cord Paralysis

Transnasal esophagoscopy (TNE), a new diagnostic technology, allows comprehensive, in-office examination of the esophagus without sedation.. To report the authors' experience using TNE.. Retrospective review of 100 consecutive patients undergoing TNE.. The most frequent indications for TNE were screening examination of the esophagus in reflux, globus, and/or dysphagia patients (n = 79), biopsy of a lesion in the laryngopharynx, trachea, or esophagus (n = 8), screening examination of the esophagus in head and neck cancer patients (n = 5), tracheoscopy and bronchoscopy (n = 4), and evaluation for an esophageal foreign body (n = 2). Four procedures were aborted secondary to a tight nasal vault. Significant findings were found in 44% (42/96). The most frequent findings were esophagitis (n = 19), Barrett's (n = 6), hiatal hernia (n = 4), and carcinoma (n = 5).. TNE is safe and well tolerated by patients with topical anesthesia alone. TNE may replace radiographic imaging of the esophagus in otolaryngology patients with reflux, globus, and dysphagia.

Topics: Anesthesia, Local; Biopsy; Conscious Sedation; Deglutition Disorders; Dilatation; Epistaxis; Equipment Design; Esophageal Diseases; Esophagitis, Peptic; Esophagoscopes; Esophagoscopy; Esophagus; Foreign Bodies; Head and Neck Neoplasms; Hernia, Hiatal; Humans; Mass Screening; Nose; Office Visits; Patient Selection; Retrospective Studies; Safety; Treatment Outcome

Enteral nutrition through filiform naso-duodenal or naso-jejunal tubes with homogeneous low molecular nutritional solutions has a rather important place in therapy of different conditions; endoscopy can help to introduce these tubes into the intestinal tract in the following situations: A leak in the upper gastrointestinal tract, which may occur after surgical resections of the esophagus or stomach, or which may occur in rare cases after bouginage or after diagnostic procedures can be passed by with an ultrathin tube until it is healed of. Patients with stenotic lesions of the esophagus or the cardia, which can not be treated by surgery or conservative procedures like pertubation and dilation can be fed enterally if it is possible to move the tube beyond the stenosis. Patients with neurogenic swallowing dysfunction of different origine can be fed during long periods of time through such filiform naso-enteral tubes successfully and reach a perfect nutritional state. In acute treatment of Crohn's disease and other inflammatory intestinal diseases enteral nutrition through tubes is an essential therapeutic procedure.

Topics: Deglutition Disorders; Duodenum; Enteral Nutrition; Esophageal Diseases; Esophageal Fistula; Esophageal Perforation; Humans; Jejunum; Nose; Radiography

Topics: Diet; Disease; Esophageal Diseases; Esophagus; Humans; Larynx; Nose; Nutritionists; Otolaryngology