The role of transnasal oesophagoscopy (TNE) in the management of head and neck cancer patients is evolving. Until 1990, oesphagoscopy required specialist endoscopists, general anaesthesia or sedation. This review succinctly summarises updates in the evidence for TNE in: i) Screening and biopsying suspicious primary tumours, second primary tumours or other non-neoplastic disease (such as reflux or ulcers seen in 64% of patients with hypopharyngeal cancer). ii) Differentiating post-treatment changes from malignancy. iii) Performing office-based procedures such as oesophageal and tracheal stricture balloon dilatation, secondary TEP (minimising mucosal lacerations) and transnasal percutaneous endoscopic gastrostomy. TNE offers the otolaryngologist the opportunity to promptly manage head and neck patients unsedated in outpatient settings; improving safety by upwards of 60% in patients with several comorbidities and minimising lip or teeth trauma. Wang et al. reported a 97% completion rate compared to 79% for conventional transoral endoscopy (attributed to barriers such as tumour size, strictures and trismus). It is highlighted that conventional endoscopy was preferred to TNE by Dolan and Anderson in the initial work-up of unknown primary cancers and large tongue-base cancers, as is advantageous in tissue manipulation / palpation and tonsillectomy can be subsequently performed under anaesthetic. Su et al. demonstrated that routine TNE screening in those with existing head and neck tumours detected earlier second oesophageal primaries. TNE is a feasible alternative for screening for a second primary, differentiating post-treatment oesophageal changes from malignancy and performing several procedures. Increased utilisation and awareness of TNE may improve morbidity and survival in the head and neck patient.

Transnasal esophagoscopy in modern head and neck surgery.
Roof A, Amin M.
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Anna Slovick

Guy's Hospital, London, UK.

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