Transnasal esophagoscopy

The distal-lighted, rigid esophagoscope was invented by Chevalier Jackson more than a century ago, and until the 1960s, with the introduction and popularization of flexible fiberoptic endoscopy, esophagology was the domain of the  otolaryngologist. In the last 50 years, other medical specialties (eg, pulmonology, pediatric surgery, gastroenterology) have joined in the evolution of aerodigestive tract endoscopy. (See also www.transnasalesophagosocpy.com).

Most esophagoscopy is now performed flexibly with endoscopes that use a charge-coupled device (CCD) to capture the images and display them on a video screen. Recent technological advances have led to further miniaturization of the CCD, allowing the production of thinner endoscopes. These newer “ultrathin” endoscopes have reached a size at which they can be passed comfortably through the nose and directed into the esophagus. In doing so, the gag reflex can be largely avoided, allowing patients to avoid sedation.

The introduction of transnasal esophagoscopy (TNE) has provided an important advance in the care of patients with reflux, dysphagia, and esophageal pathology. The TNE endoscope offers brilliant illumination and excellent image quality with air-insufflation and irrigation capability through a 2-mm working channel, which can also be used to obtain biopsies and/or to perform procedures. Since 2000, otolaryngologists have popularized TNE and expanded its diagnostic applications for globus, dysphagia, laryngopharyngeal reflux (LPR), and gastroesophageal reflux disease (GERD).

In this paper, we will discuss the role of TNE in clinical practice and review the literature with regard to the utility of the TNE in diagnosing pathology in the esophagus.

Read more: Transnasal esophagoscopy: A position statement from the American Bronchoesophagological Association (ABEA)
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Milan R. Amin, MD, Gregory N. Postma, MD, Michael Setzen, MD, and Jamie A. Koufman, MD, New York City, Manhasset, and Valhalla, NY; and Augusta, GA

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