ENT Care - Panendoscopy and biopsy

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What is panendoscopy and biopsy? Panendoscopy is examination of the upper part of the aerodigestive tract (the swallowing and breathing part of the head and neck. It can also include inspection of the upper part of the airways, including the trachea and right and left main bronchus. It includes pharyngoscopy, nasendoscopy, laryngoscopy (+/-microlaryngoscopy), bronchoscopy & oesophagoscopy. Not all of these may be done however. A biopsy of any suspicious areas can be done during this procedure.

Why do I need panendoscopy? This is performed to look for any problems inside the neck area and throat area. It is commonly performed to 'rule out' any lumps or bumps inside the throat, and occasionally to remove things from the throat, such as food that has got stuck.

How is the operation done? This procedure is done under general anaesthesia, whilst you are asleep. It can often be preformed as day case surgery with excision or biopsy of any abnormal tissue if present.

What is oesophagoscopy? Oesophagoscopy is the examination of your gullet (oesophagus) while you are under a general anaesthetic. It is done to check and sometimes treat of the gullet, such as difficult or painful swallowing.
A long metal tube (oesophagoscope) is passed via your mouth into your gullet. This allows the surgeon to look at the inside the oesophagus to find any problems that may be affecting your swallowing.
If there are any problem areas, a small part of the lining of the oesophagus is taken away for laboratory examination. This is called a biopsy. Oesophagoscopy is quite a short operation and usually takes less than 20 minutes.

How will I feel after the operation? After oesophagoscopy, you may find that your throat hurts. This is because of the metal tubes that are passed through your throat to examine the oesophagus. Any discomfort settles quickly with simple painkillers and usually only lasts a day or two.
Some patients feel their neck is slightly stiff after the operation. If you have a history of neck problems, you should inform the surgeon about this before your operation.

After oesophagoscopy, some people may not be allowed to eat or drink for a few hours, until your surgeon is happy there have been no complications.

Possible complications:

Oesophagoscopy is very safe. You may have a slightly sore throat afterwards. Very rarely, there is a risk that the metal tubes may chip your teeth. A gum guard is used to help prevent this happening
Swelling of the tissues of the airway may lead to difficulty breathing, If this occurs the breathing tube used during th operation is reinserted until the swelling settles. Very rarely a tracheostomy tube (insertion of a breathing tube through the neck) may be required depending on the underlining problem
Bleeding can also occur leading to difficulty in breathing, with the same management as for breathing trouble. Bleeding usually settles spontaneously, but may require surgery to sort it out.
Voice change. The larynx (voice box) or the nerves controlling the larynx may be injured by the instruments used for panendoscopy. Voice change may also result from excision or from biopsies of any abnormal tissue in the larynx. Whilst the voice change may be persistent, usually it returns to normal
Perforation or rupture of the oesophagus (food passage). This may lead to a serious infection in the neck or chest which can be life threatening. Surgery in the neck and/or chest maybe required to repair the perforation and treat the infection and a prolonged stay in hospital will be required. This is very rare indeed.
Persistence or recurrence of the original disease
Injury to undiagnosed neck or spinal problems (I am careful to avoid any undue extension of the neck).

When will I know what happened? Your surgeon will usually be able to tell you, on the day of the operation, what was found, and what was done. If any biopsies were taken, these normally take a few days to process in a laboratory. You will be seen in clinic to discuss this further.

When can I go home?

Often you can go home the same day as the operation, as long as you have someone with you. Depending on how you feel afterwards, you may need to stay overnight for observation.
You may be advised to stay off work for a few days to rest your throat, depending on your job.

Is there any alternative treatment?

Oesophagoscopy is the suitable technique used for examining the upper part of the oesophagus. However if you need your lower oesophagus or stomach looked at then a fibreoptic gastro-oesophagoscope is used. This examination will be performed by a gastroenterologist who will be able to tell you what to expect.

Pharyngoscopy is examination of the swallowing passage to the level of the collar bone. This allows inspection of the throat, to look for problems or to undertake biopsies. Risks etc are as for oesophagoscopy.

Laryngoscopy is examination of the voice box: see microlaryngoscopy

Nasendoscopy This is examination of the nose and the back of the throat. It is usually performed with a flexible nasendoscope in clinic. However if biopsies are required, the is performed in the operating theatre.

Bronchoscopy is examination of the wind pipe (trachea) and the right and left main bronchus that comes off the trachea. This is performed to remove inhaled items from the chest, or to take biopsies of growths that have extended down past the vocal cords.

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