Transnasal Esophagoscopy Reduces Major Complications in Diagnosing

May 21, 2004

WINSTON-SALEM, N.C. – A new method of diagnosing swallowing disorders and problems caused by gastroesophageal reflux can significantly reduce the major complications associated with traditional esophagoscopy, a physician from Wake Forest Baptist Medical Center reported at a conference here today.

The new method is called transnasal esophagoscopy (TNE), “and it’s a huge advance,” said Greg Postma, M.D., associate professor of otolaryngology at Wake Forest Baptist and one of the course directors for the “Laryngopharyngeal Reflux, Dysphagia, and Laryngology” conference being held here May 20-22.

TNE employs an endoscope that is only about 5 millimeters in diameter and is threaded through the nose, down the throat and esophagus and into the stomach, with no sedation and only a topical anesthetic in the nose and throat.

Traditional esophagoscopy, Postma explained, requires heavy sedation by intravenous injection, while a larger endoscope is deployed down the esophagus through the mouth. “More than half the complications of esophagoscopy are due to sedation. So we eliminate more than half the complications just by the nature of how we do it.”

Postma said that Wake Forest Baptist had done more than 700 TNE procedures without a single major complication and only eight minor complications. “The key is that it’s easier and safer,” he said.

“When we use that (smaller) scope we can biopsy things just about anywhere,” Postma said. TNE can be used to detect and biopsy precancerous lesions in the esophagus, as well as fungal infections, strictures (narrowings), pouches and other abnormalities.

A major advantage of TNE is convenience for the patient, Postma said. “When you have this done, you walk out of the clinic and drive yourself home,” in contrast to the traditional method, in which the patient spends an additional two hours in the recovery room, with restricted activity for at least the remainder of the day.”

More than 200 medical professionals from around the world were expected for this week’s conference, which includes a hands-on TNE course.

The conference was designed to discuss new technology, diagnostic techniques and the impact of laryngopharyngeal reflux on swallowing and voice disorders. The conference is cosponsored by the Center for Voice and Swallowing Disorders of Wake Forest Baptist and the American Broncho-Esophagological Association.

Presentations include the role of laryngopharyngeal reflux (LPR) (the backflow of gastric contents into the voice box and throat) and the differences between LPR and gastroesophageal reflux disease (GERD), commonly referred to as acid reflux.

In addition to Postma, course directors for the conference are Jamie Koufman, M.D., and Peter Dettmar, Ph.D., from Wake Forest Baptist, and Julian McGlashan, M.D., of University Hospital, Queens Medical Centre, Nottingham, England.

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