Diagnosis of nasopharyngeal disease during upper GI endoscopy

Abstract

Nasopharyngeal examination is usually not part of upper gastrointestinal (GI) endoscopy but could be used to potentially diagnose early lesions in this area. We present preliminary results of nasopharyngeal inspection either at the start (insertion) or after (withdrawal) performance of upper GI endoscopy in 1550 patients, with a technical success rate of 97.6%. Two early-stage cancer cases were identified, and 439 patients had nasopharyngeal diseases of variable relevance. Mild complications were observed in 6.1%. This technique should be systematically evaluated for screening in high-risk areas. Malignant nasopharyngeal diseases, particularly nasopharyngeal carcinoma, are challenging to detect due to their non-specific symptoms, the anatomical location of the nasopharynx and the lack of cost-effective routine screening methods.1 Consequently, over 70% of nasopharyngeal carcinoma cases are diagnosed at advanced stages (III or IV) during the initial presentation,2 with a 5-year overall survival of about 50%. However, when nasopharyngeal carcinoma is detected at early stages, the 5-year overall survival approaches 95% or higher.3 4 The current diagnostic gold standards—rhinolaryngoscopy and transnasal gastroscopy with histological examination—are unsuitable for routine screening due to their lack of cost-effectiveness and, as diagnostic tools, suffer from technical limitations such as image sensor size, optical fibre count, field of view and lack of magnification capability, which significantly reduce image quality.5 6 Upper GI gastroscopy, one of the most commonly performed diagnostic procedures, is the standard method for diagnosing various GI diseases and is used for screening in some high-risk areas for oesophageal or gastric cancer.7 8 Studies have demonstrated that systematic assessment of the pharynx during gastroscopy can enhance the detection of pre-cancerous and incidental otolaryngologic lesions.9 10 However, it was previously thought that the nasopharynx could not be visualised during upper GI endoscopy unless a nasal entry was performed.11 Since most malignant nasopharyngeal diseases occur …