Post written by Ylanna Fortes, MD, Renata Nobre, MD, PhD, Bruno da Costa Martins, MD, PhD, and Fauze Maluf-Filho, MD, PhD, from the Department of Endoscopy, Cancer Institute of São Paulo, University of São Paulo, São Paulo, Brazil.
A 71-year-old man with a history of esophageal squamous cell carcinoma underwent surveillance endoscopy. During systematic examination of the oral cavity and pharynx, we found a subtle flat lesion that might have easily been missed. Biopsy findings showed high-grade dysplasia. We performed pharyngeal endoscopic submucosal dissection, and histopathology confirmed in situ carcinoma with free margins and no lymphovascular invasion. The video follows the case from detection to resection.
Superficial pharyngeal cancers can be easily missed during routine endoscopy. In this video, we display the importance of the oral cavity and pharynx evaluation in high-risk patients. We also share a practical approach that endoscopists can incorporate into their examinations.
The first step is to make the oropharyngeal examination part of the routine in high-risk patients. For endoscopists performing pharyngeal endoscopic submucosal dissection, the video provides a step-by-step approach and practical tips for this challenging location.
Our key message: look carefully to the pharynx of high-risk patients. Finding a subtle lesion can make early diagnosis and curative endoscopic treatment possible and prevent the patient from the morbidity of a late diagnosis with more-extensive treatment.
Virtual chromoendoscopy evaluation demonstrating intrapapillary capillary loops similar to B1 on the Japanese Classification of Esophageal Cancer.
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