Panendoscopy entails a complete evaluation of the upper aerodigestive tract, and consists of oral inspection, direct laryngoscopy, bronchoscopy, oesophagoscopy, or some combination of these procedures. Despite many advances in imaging over the years, a skilled surgeon’s eyes remain superior in detecting abnormality, and the true extent of a lesion. Historically, oesophagoscopy is recommended in the evaluation of patients with head and neck squamous cell carcinoma (HNSCC), to exclude synchronous oesophageal tumours. However, this procedure can be fraught with dangers, not least the dreaded oesophageal perforation.
This article reviews the current evidence and the authors chose four retrospective studies (level 3) and one retrospective study of a prospectively collected cohort (level 3). The recommendation is that since the overall incidence of oesophageal secondary malignancies is low, in the absence of concerning imaging findings, routine oesophagoscopy is not necessary in many HNSCC patients.
There are exceptions to this rule of course, and they include primary tumours of the larynx/hypopharynx, abnormal imaging findings in the oesophagus, or the inability to undergo PET/CT.