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Endoscopic evaluation is frequently performed before bariatric surgery to identify foregut pathology that may alter procedure selection. Transnasal endoscopy (TNE) is an alternative to esophagogastroduodenoscopy (EGD). The objective of this study was to compare TNE to EGD. Patients who underwent TNE or EGD before bariatric surgery from January 2012 through April 2019 were reviewed. Statistical analyses included Chi-square, Wilcoxon two-sample, and Fisher’s exact tests. A p value

Functional electrical stimulation (FES) is considered an upcoming treatment modality for a number of laryngeal diseases. However, sound data are scarce when it comes to surface FES to treat voice disorders. Aim of the present study was to identify and differentiate suitable surface FES patterns to activate internal laryngeal muscles. Non-invasive FES was performed in a cohort of 17 elderly woman. Our user-customized electrical stimulation setup allowed us to deliver ten different stimulation patterns (rectangular and sawtooth shaped) with variation of frequency and amplitude. Stimulation outcome, i.e., vocal fold (VF) reaction, was continuously verified by transnasal endoscopy. Responses to FES using ten different stimulation patterns varied inter-individually. None of the stimulation parameter sets could elicit a VF reaction in all participants. Based on our findings we conclude that individual fitting is necessary when defining surface stimulation parameters. To overcome limitations of previous studies, devices with freely programmable patterns are required as shown here. Endoscopic control of VF reaction is absolutely essential to ensure effectiveness of the delivered patterns.

Purpose Flexible transnasal endoscopy is a common examination technique for the evaluation of laryngeal lesions, while the use of narrow band imaging (NBI) has been reported to enhance the diagnostic value of white light endoscopy (WLE). The purpose of this study is to assess observer variability and diagnostic value of both modalities and investigate the possible influence of previous laryngeal surgery on the detection rates of laryngeal malignancy. Methods The study was based on the retrospective evaluation of 170 WLE and NBI images of laryngeal lesions by three observers in a random order. The histopathological diagnoses serve as the gold standard. Results In identifying laryngeal malignancy, the sensitivity of NBI proved to be higher than that of WLE (93.3% vs. 77.0%). NBI was also superior to WLE in terms of accuracy (96.3% vs. 92%) and diagnostic odds ratio (501.83 vs. 120.65). Both modalities had a specificity of 97.3%. The inter-observer agreement was substantial (kappa = 0.661) for WLE and almost perfect (kappa = 0.849) for NBI. Both WLE and NBI showed a high level of intra-observer agreement. The sensitivity was significantly lower in images with history of previous laryngeal surgery compared to those without. Conclusions Flexible transnasal endoscopy has been proved to be a valuable tool in the diagnosis of laryngeal malignancy. The use of NBI can increase the sensitivity and observer reliability in that context and can also provide a diagnostic gain in cases with previous laryngeal surgery

In the past decade, surgical treatment of skull base pathologies has greatly advanced through the advent of the endoscope and later of the high definition endoscope. Recently a new type of three dimensional (3D) scope has been introduced to permit the surgeon a real stereoscopic vision of the operating field and to overcome the limitations of the 2D endoscopic set up. As with all new technologies a formalized adaptation period is essential for the surgeon to secure steady outcomes and low complications. To determine the subjective difficulties that one may encounter during this sensitive period we therefore devised and analyzed a questionnaire that evaluated the first ten procedures with the 3D device of junior and senior ENT and neurosurgeons. 52 consecutive patients were treated with purely 3D transnasal endoscopy for skull base pathologies. Sensation of strain or dizziness, difficulties in anatomical orientation and difficulties in performing the surgical gesture were assessed for each surgeon. The learning curve and difficulties of junior and senior surgeons are discussed and strategies to overcome the initial problems are devised. Our results confirm that after only few procedures, the advantages of the 3D endoscopic system including better visualization and depth perception are able to outweigh the inconveniences that go hand in hand with the learning of a new skill set.

Early gastric cancer located from the pyloric ring to inside the duodenal bulb (DB) is not easily treated by endoscopic submucosal dissection (ESD). The endoscope needs to be reversed inside the DB to set the resection line at a safe distance from the anal side. Because of the space limitations and limited flexibility of conventional endoscopy (CE), there have been increasing possibilities of complications. Here we report a new ESD technique using a transnasal endoscope (TN-E) that is reversed inside the DB.The subjects were 5 patients with early gastric cancer or adenoma, at locations ranging from the pyloric ring to inside the DB, who were all treated by ESD. We compared results in these patients (TN-E group) with results in five patients with similar disease characteristics who were treated by ESD before July 2008, when the TN-E treatment method was introduced (CE group). In the TN-E group, after marking by CE, we switched the endoscope to the TN-E, and performed the reversing procedure inside the DB, and cut the anal side of the lesion in a semicircle. We switched back to CE to dissect the remaining half on the oral side. We compared the average resection time, en-bloc resection rate, and safety margin between the TN-E and CE groups.Reversing inside the DB and the anal-side procedures proved easy and there were no complications. No bleeding or perforation occurred. The average resection times and en-bloc resection rates were not different between the two groups. All the resections by the TN-E were more than 5 mm away from the tumor margin, whereas a resection rate with a safety margin of more than 5 mm was 80% by CE.In conclusion, the TN-E was safe and effective for use inside the DB. ESD using the TN-E contributed to accurate pathological diagnosis, because the size of the resected specimen was sufficient to prevent the burning effect caused by the ESD.

Ausgedehnte Tumoren der Mundhohle, des Pharynx und Larynx, besonders Rezidivtumoren und Zustand nach Radiotherapie konnen eine erforderliche endotracheale Intubation erheblich erschweren. Die transnasale fiberoptische Intubation erfordert ebenso wie die Tracheostomie unter Lokalanasthesie ein hohes Mas an Kooperation, und diese Mitarbeit ist bei Tumorpatienten mit reduzierten Allgemeinzustand und Dyspnoe nicht immer gegeben. Bei entsprechenden, ausgewahlten Patienten wurde in 16 Fallen eine Koniotomie in Lokalanasthesie unter einer bedarfsadaptierten i.v.-Sedierung durchgefuhrt. Erst nach gesicherter Beatmung wurde die Narkose eingeleitet. Die Koniotomie wurde alternierend von einem Anasthesisten oder HNO-Arzt vorgenommen und in allen 16 Fallen nach Abschluss der chirurgischen Masnahmen verschlossen. In 15 Fallen wurden die Atemwege durch Anlage eines permanenten Tracheostomas gesichert. Die Moglichkeiten einer konventionellen Intubation wurden retrospektiv vom Anasthesisten beurteilt: In einem Fall wurde sie als leicht moglich, in 10 Fallen als nahezu unmoglich eingeschatzt. Bis auf eine kurzzeitige Wundheilungsstorung traten keine Komplikationen auf, und die potenziell lebensbedrohliche „Cannot-ventilate-cannot-intubate“-Situation konnte in allen Fallen vermieden werden. In ausgewahlten Fallen mit ausgedehnten Tumoren im Bereich der oberen Luftwege hat sich die passagere Koniotomie zur Sicherung der Atemwege bewahrt.

Although different pathophysiological mechanisms have been suggested to be involved in functional dyspepsia, a practical method to clarify them has not been established. The aim of this study was to evaluate dyspeptic symptoms and gastric motility induced by duodenal acidification using transnasal endoscopy.Fourteen healthy volunteers (mean age, 32 years) were enrolled. Transnasal endoscopy was performed on all fasting volunteers. Dyspeptic symptoms and antral contractions were evaluated before and after duodenal infusions of pure water (20 ml/min for 5 min) and acid (0.1 N HCl, 20 ml/min for 5 min). The severity of various symptoms was assessed by each subject using a 10-cm visual analog scale every 2 min. The maximum severity scale was calculated as the mean of the individual maximum values. The motility number was defined as the mean number of antral contractions in 1 min.The maximum severity score for a heavy feeling in the stomach and other symptoms significantly increased after the acid infusion compared with after the pure water infusion. During pure water infusion, there were no changes in the motility number. On the other hand, the motility number significantly decreased after duodenal acidification (before vs. after, 2.93 +/- 0.12 times vs. 1.11 +/- 0.23 times, P0.0001).Duodenal acid exposure induces dyspeptic symptoms and inhibits antral motility. Transnasal endoscopy enabled us to evaluate both dyspeptic symptoms and gastric motility simultaneously.

Congenital choanal atresia has been recognized for over 200 years, first described by Roederer in 1775 (Lantz and Brick, Laryngoscope 91, 1981, 1626. Samuel and Fernandes. Laryngoscope 95, 1985, 326). This condition is unconunon, occurring in approximately 1 in 7000 live births. Unfortunately, a single ideal procedure for this condition does not exist. Stankiewicz is credited with the first description of endoscopic techniques for choanal atresia repair. All patients diagnosed to have choanal atresia treated between 1999 and 2000 were reviewed. Out of four patients two underwent endoscopic repair. This article attempts to address this controversy between endoscopic and traditional approaches to neonatal choanal atresia.