Flexible Fiberoptic Endoscopy Research Articles

Obstruction of the Eustachian Tube Orifice and Pressure Changes in the Middle Ear: Are They Correlated?

We performed a cross-sectional study to investigate whether the obstruction of the eustachian tube orifice due to adenoid hyperplasia changes the pressures in the middle ear. Fifty consecutive children 2 to 12 years of age with nasal obstruction were examined from May to October 2005. Adenoid size and status of the eustachian tube orifice were assessed with nasal flexible fiberoptic endoscopy. Tympanometry was used to evaluate the middle ear. In children with occlusion of the eustachian tube orifice by adenoid tissue, 87% had abnormal pressure in the middle ear according to tympanograms. When orifices were not occluded, 86% of the tympanograms were normal (p < .001). Obstruction of the eustachian tube orifice by adenoid tissue was associated with tympanograms suggestive of abnormal pressure in the middle ear. Future studies with a larger sample size are necessary to clarify this association.

Examination of the Larynx and Pharynx

This video demonstrates examination of the larynx and pharynx using indirect laryngoscopy, with either a simple dental mirror or a flexible fiberoptic endoscope.

Effects of flexible fiberoptic endoscopy on pharyngeal swallow physiology

The purpose of this study was to determine if the presence of a flexible fiberoptic endoscope in the pharynx affects swallow physiology. This was a prospective cohort study. Fourteen individuals with normal swallow function, 23 to 83 years of age, completed a videofluoroscopic swallow study with and without a 3.5 mm flexible fiberoptic endoscope maintained in the "high" position, ie, below the velopharyngeal port and above the epiglottis. Each study was analyzed for three swallow duration measures, number of swallows necessary to clear the bolus, and penetration-aspiration scale scores. No significant (P > 0.05) main effects for condition were found for swallow duration, penetration-aspiration scale scores and number of swallows to clear the bolus. The presence of a flexible fiberoptic endoscope in the pharynx during swallowing did not significantly affect pharyngeal swallow physiology in the patients studied, but we cannot exclude a false-negative conclusion because of low statistical power.

Sensitivity and specificity of nasal flexible fiberoptic endoscopy in the diagnosis of adenoid hypertrophy in children

To evaluate nasal flexible fiberoptic endoscopy as a diagnostic test of adenoid hypertrophy in children with nasal obstruction. One hundred and thirty consecutive children aged 2-12 years were examined from May to October 2005. A questionnaire answered by parents or guardians was used to obtain a symptom score. Adenoid size was measured on radiographs of the nasal cavity using the Cohen and Konak method, and by nasal flexible fiberoptic endoscopy using the Wornald and Prescott classification. The criterion standard was the adenoid size demonstrated on radiograph. The sensitivity of nasal flexible fiberoptic endoscopy was 92% (95% CI, 0.90-0.93), and specificity, 71% (95% CI, 0.70-0.72). The area under the ROC curve was 0.83 (95% CI, 0.76-0.90) at a p<0.001 level of significance. Kappa values were 0.94 (p<0.001) for interobserver agreement, 0.95 (p<0.001) for intraobserver agreement, and 0.54 (p<0.001) for agreement between tests. Results suggest that nasal flexible fiberoptic endoscopy is a highly accurate diagnostic method. This examination can be performed easily in cooperative children; it is safe, objective and dynamic, and helps to establish diagnoses in difficult cases.

Management of the unknown primary carcinoma: Long‐term follow‐up on a negative PET scan and negative panendoscopy

The unknown primary carcinoma in the head and neck has been estimated to represent up to 7% of all head and neck carcinomas. In an attempt to identify the occult primary tumor the evaluation of this patient population has included a complete head and neck examination, flexible fiberoptic endoscopy, and imaging with CT/MRI. More recently, positron emission tomography (PET) has been advocated as a tool to detect primary tumors. A cohort of 31 patients with fine-needle aspiration biopsy-confirmed squamous cell carcinoma were prospectively entered into a diagnostic protocol to identify the occult primary tumor. The diagnostic protocol included a comprehensive head and neck examination (including flexible endoscopy) and CT and/or MRI. If the initial diagnostic evaluation failed to identify a primary tumor, the patients then underwent whole body PET imaging followed by staging endoscopy with biopsy of the at-risk occult tumor sites. The outcome measures included the accuracy of the PET to predict the presence of occult tumor at staging endoscopy and the accuracy of the negative PET and negative panendoscopy in predicting the subsequent development of a primary tumor in the upper aerodigestive tract during follow-up. The PET detected 9 occult primary tumors in the 31 patients (detection rate, 29%). Five occult primary tumors (2 base of tongue and 3 palatine tonsil) were detected during panendoscopy despite a negative PET. The combination of PET and panendoscopy detected 45.2% of the unknown primary tumors. Seventeen patients (N1, n = 7; N2a, n = 4; N2b, n = 2; N3, n = 4) had no primary tumor detected and were treated as an unknown primary carcinoma with primary neck dissection +/- radiation therapy +/- chemotherapy. In this series of 17 patients, there were 3 neck recurrences (17.6%). In addition, only 1 patient (5.8%) developed a primary tumor of the upper aerodigestive tract with a mean follow-up of 31.1 months (range, 21-60 months). A negative PET study in patients with an occult primary head and neck carcinoma does not preclude the need for panendoscopy with biopsy to detect the occult primary tumor. The risk of subsequent primary tumor appears to be low in the patients with a negative PET and a negative panendoscopy (<6%).

Bildgebende Diagnostik des Darms - eine Neubewertung, Teil 1

For decades fluoroscopy was the only adequate imaging modality in the diagnostic evaluation of the bowel. In the 1980 s new techniques such as MRI, CT and flexible fiber-optic endoscopy were introduced into the daily routine and revolutionized bowel imaging. Wireless capsule endoscopy (WCE) is the latest technical innovation for visualizing the bowel. Today a broad range of different imaging methods is available. This article provides a review of state-of-the-art bowel imaging and is divided into two parts. The first part addresses conventional X-ray techniques and ultrasonography and the second part discusses bowel imaging with computed tomography (CT) and magnetic resonance imaging (MRI). The goal of this article is to present the imaging techniques and to discuss them in the context of competitive methods.

State of the States 2006

State of the States 2006

Radiology Quiz Case

A 1-MONTH-OLD BOY WITH A HISTORY OF PREmaturity, duodenal atresia, and multiple skin hemangiomas underwent flexible fiberoptic endoscopy for workup of mild inspiratory stridor, dysphagia, and aspiration. Previous videofluoroscopic evaluation of his swallowing function had demonstrated moderate oral aversion, poor laryngeal sensitivity, and aspiration. Flexible fiberoptic examination of his larynx demonstrated normal true vocal cord function, pooling of secretions, and an intra-arytenoid area, which was suggestive of a laryngeal cleft. Formal direct laryngoscopy and bronchoscopy were scheduled to further inspect his intraarytenoid region. Direct laryngoscopy and bronchoscopy demonstrated several anatomical anomalies, including a type 1 laryngeal cleft (Figure 1), a small, nonobstructing, leftsided subglottic hemangioma, and an unusual “trifurcation” configuration at the carina (Figure2). Because there was a concern regarding a possible tracheoesophageal fistula with the history of aspiration, an attempt was made to pass a pediatric flexible bronchoscope into each of the distal orifices. Unfortunately, the orifice size would not allow the flexible bronchus to pass distally. Because of the atypical appearance of the carina and the patient’s history of respiratory problems, a computed tomogram of the chest was obtained (Figure 3). What is your diagnosis?

Video assisted fiberoptic intubation for temporomandibular ankylosis

In the era of fiberoptics, securing of the airway under general anesthesia in small children with temporomandibular joint ankylosis without a flexible pediatric fiberoptic endoscope requires considerable skill. We describe the use of an adult flexible fiberoptic laryngoscope with a video camera system to visualize the glottis from one nostril while the tracheal tube was passed from the other nostril.

Office Procedure For Management Of Foreign Body: Cricopharynx

Introduction: There are few reports of removal of impacted foreign bodies in the cricopharynx as office procedure. This is the retrospective review of 114 consecutive patients of Foreign Body Cricopharynx reporting between years January 1992 to August 2005. Set up: Tertiary Care (Medical College) Hospital. Material, Methods And Results: Out of 114 patients with foreign bodies in cricopharynx (average age 7.6 years), we have removed F Bs in 111 cases successfully in E.N.T. outdoors without early or late complications. The instruments used were Macintosh laryngoscope and Laryngeal foreign body forceps. Three patients were subjected for Flexible Fibreoptic Endoscopy of oesophagus, as F Bs had descended down during the course of treatment. Conclusion: This study suggests that removal of FB in cricopharynx, as outdoor procedure, is both safe and cost effective. This paper was presented in the First International Conference of Rural Surgeons held in September 2005 at UJJAIN (MP).

The insertion of oesophagogastric tubes in malignant oesophageal strictures: endoscopy or surgery?

Oesophagogastric tubes were inserted into 16 patients with malignant strictures of the distal oesophagus by a method employing the flexible fibreoptic endoscope, and these patients were compared with 28 patients in the same hospital whose tubes were inserted by surgical methods. Four patients (25 per cent) in the endoscopic group died in the immediate post-insertion period as a result of the procedure, compared with 13 patients (45 per cent) in the surgical group. Of the remainder, the majority were mobilized and taking diet on the day following the procedure, and the morbidity associated with the surgical method was not seen in the endoscopic group. It is concluded that the endoscopic insertion of oesophagogastric tubes has advantages over surgical insertion in the palliation of malignant oesophageal strictures.

Integrated simultaneous dual-modality imaging endospeckle fluoroscope system for early colon cancer diagnosis

An integrated and flexible fiber optic endoscope system for diagnostic investigations in medical cavities using specially designed probe distal and proximal ends so as to facilitate simultaneous speckle correlation analysis and fluo- rescence spectroscopic imaging is presented. © 2005 Society of Photo-Optical Instrumentation Engineers. DOI: 10.1117/1.2117487

The Evolution of Endoscopy: Wireless Capsule Cameras for the Diagnosis of Occult Gastrointestinal Bleeding and Inflammatory Bowel Disease

Occult gastrointestinal bleeding and lesions associated with inflammatory bowel disease represent a diagnostic dilemma because they often lie in areas of the small bowel that are difficult to access with flexible fiberoptic endoscopy. Capsule endoscopy has been developed to access these areas in a way that avoids the pain and anesthesia risks of push endoscopy. The diagnostic yield of capsule endoscopy has proven to be superior to both flexible small-bowel endoscopy and radiologic studies in several prospective trials. Capsule endoscopy transmits a large number of images that do not correlate well with the standard endoscopic view, creating a diagnostic challenge for the endoscopist. Complications of this procedure include capsule retention in diverticulae or at stricture sites. The technology of this procedure continues to evolve through improving image resolution and diagnostic accuracy. Capsule endoscopy also represents an overall economic saving despite a high unit price compared with the expense of repeat diagnostic testing. Because the diagnostic yield of capsule endoscopy is nearly twofold greater than conventional endoscopy, it has become the procedure of choice for the dilemma of assessing small-bowel pathology for many clinicians. Further studies are needed to determine whether the capsule endoscope can replace conventional endoscopy in the first-line diagnosis of pathology in other parts of the alimentary tract.

Digestive Endoscopy in Neonates

Since the introduction of flexible fiberoptic endoscopy in the early 1970s, esophagogastro-duodenoscopy and colonoscopy have become established procedures for the diagnosis, evaluation and treatment of gastrointestinal tract disease in the pediatric population. The development of safe fiberoptic endoscopes specially designed for neonates has allowed visualization of lesions occurring in the first days of life. Despite an increased understanding of neonatal digestive disorders deriving from this new diagnostic modality, there is little consensus on the appropriate use of endoscopic procedures in routine care of neonates. It is the feeling of the authors that widening the indications of endoscopy in the neonatal period might lead to diagnosis of discrete clinical abnormalities, which might improve the care of neonates. The techniques for performing neonatal endoscopies, the appropriate indications, the common normal and pathologic findings and the complications of these procedures are reviewed.

Effectiveness of the Jaw-Thrust Maneuver in Opening the Airway: A Flexible Fiberoptic Endoscopic Study

Objective: A prospective study was carried out to find the exact site of obstruction in sleep model and to quantitatively evaluate the effect of Jaw-thrust maneuver (JTM) in opening the obstructed airway using flexible fiberoptic endoscope. Methods: Twenty-eight ASA physical status I or II patients with snoring symptom undergoing elective surgery were included. The patients were held in supine position without hyperextension of the neck. Having induced anesthesia, the base of the tongue and laryngeal inlet and/or epiglottis were visualized using endoscope. The patients’ epiglottides were classified as leaf-shaped, curved (concaved or omega-shaped) and floppy types. We graded the airway opening at the level of epiglottis into six grades and obstruction at the tongue base level into four grades. The grades during inspiration (GrIns), expiration (GrExp) and after JTM (GrJTM) were recorded and compared with Pearson chi-square test. Results: The strictly curved (Ω-shaped or concaved) epiglottis supplied a salvage pathway for airflow that resisted collapsing with the posterior movement of the tongue base in 2 patients. When we compared GrIns with GrExp for epiglottis the difference was statistically significant (χ² = 0.001), but the difference for tongue base was not (χ² = 0.152). After JTM, GrJTM for both epiglottis and tongue base were significantly better than GrIns and GrExp (χ² < 0.001). Conclusion: Tongue base was the principal site of obstruction although during the respiratory cycle the position of epiglottis changed prominently and increased the obstruction in inspiration. JTM alone significantly relieved the obstruction at the tongue base and epiglottis levels and increased the retroglossal airway.

Insuffisance vélopharyngée

Velopharyngeal incompetence is a disease that occurs most of the time in children. Its therapeutic management involves several specialists (an ENT surgeon, a maxillofacial surgeon, and a speech therapist). The complexity of the disease is related to both the anatomy and the physiology of the velopharyngeal sphincter, as well as to the multiplicity of potential aetiologies (functional, neurological, surgical, etc.). Investigations for such incompetence must include Magnetic Resonance Imaging (MRI), flexible fiberoptic endoscopy and aerodynamic tests. The treatment is firstly based on phoniatric evaluation, then on a speech therapy that must be undertaken as early as possible, and that must precede and follow any surgical treatment. Surgery of velopharyngeal incompetence has no gold standard. There are many techniques available, among which the most famous are the velopharyngoplasties and active or passive pharyngoplasties.

From the Lumen to the Laparoscope

Throughout the ages, the issues that have defined the management of disease processes have been particularly exemplified in the gastrointestinal tract. The use of gas lamps and candles with reflectors by Bozzini, Segalas, Cruise, and Fisher (19th century) allowed for some ingress into both the upper and lower gastrointestinal tract. Von Mikulicz, Leiter, Nitze, Kelling, and Jacobaeus contributed to the development of rigid instruments that could be used endoscopically or laparoscopically. Endoscopic efforts were amplified and extended by Rosenheim, Sternberg, Wolf, and, finally, Schindler, who not only introduced novel lens systems but also for the most part overcame the problems of flexibility and illumination. Bernheim, Ruddock, Veress, and Palmer made significant technical and clinical contributions to abdominal cavity exploration. The subsequent application of Hopkins and Kapany's work on optics, and the development by Hirschowitz and Curtiss of the flexible fiber optic endoscope, enabled the design of instruments that would allow the appropriate illumination and vision of both the farthest reaches of the bowel as well as the interior of the abdomen. Thus, the same endoscopic instruments coupled with a surgical interest in diagnostic laparotomy allowed for the evolution of minimally invasive surgery along a similar timescale. The cycle whereby diagnostic laparotomy in the early part of the century was supplanted by endoscopy and laparoscopy has now attained full circle whereby laparoscopy has evolved from a diagnostic procedure into one with major therapeutic applications and is perceived as the state-of-the-art technique for a wide variety of operations, including appendectomy, cholecystectomy, hernia repair, fundoplication, splenectomy, colectomy, and gastrointestinal anastomoses.

Chronic rhinosinusitis and adenoid hypertrophy in children

Purpose The purpose of this study was to investigate the relationship between adenoid microbiology, adenoid size, and maxillary sinus microbiology in children with both chronic rhinosinusitis and adenoid hypertrophy. Methods The children with both chronic rhinosinusitis and adenoid hypertrophy were admitted to this prospective study. The study included 30 children. The diagnosis of chronic rhinosinusitis was based on clinical and radiologic examinations. Adenoid hypertrophy was classified as medium and large based on the preoperative flexible fiberoptic endoscopy and nasal endoscopy during surgery. Maxillary sinus aspiration and adenoidectomy was performed in all patients. Sinus aspirate and adenoid tissue specimens were cultured. The correlation of culture results was investigated. The relationship between adenoid size and maxillary sinus culture results was analyzed by using chi-square test. Results Adenoid sizes were medium in 12 (40%) and large in 18 (60%) cases. Bacterial growth was found on 14 of 30 (47%) sinus aspirate, and all adenoid specimen cultures showed bacterial growth (100%). There was no statistical correlation between cultures obtained from the adenoid tissue with those from the maxillary sinus. The relationship between adenoid size and maxillary sinus culture results was not found statistically significant (χ 2 = 0.96, P = 1.0). Conclusion The reason that there was no correlation between cultures obtained from the adenoid tissue with those from the maxillary sinus is that it seems possible that the adenoids act as a barrier causing mechanical obstruction rather than a nidus for chronic sinus infection. However, there is no relationship between adenoid size and maxillary sinus culture positivity. Medium adenoids causing partial obstruction may lead to changes in the microenvironment and may start bacterial growth in children with positive maxillary culture. Further investigation is needed to explain the association between adenoid hypertrophy and rhinosinusitis. Adenoidectomy helps to resolve the symptoms of chronic rhinosinusitis in the children with both chronic rhinosinusitis and adenoid hypertrophy.

Pulmonary and sinus diseases in primary humoral immunodeficiencies with chronic productive cough

Aims: To prospectively evaluate sinopulmonary disease in 24 patients with primary humoral immunodeficiency (11 with agammaglobulinaemia, nine with isolated IgA deficiency, and two with common variable immunodeficiency) and chronic productive...

Wireless capsule endoscopy

With the introduction of the flexible fiber optic endoscope in 1950s visualization of the esophagus, stomach, upper small bowel and colon became possible. The flexible shaft of the instrument carried the fiber optic light bundles, power and the optical elements. It also contained cables, which allowed for control over the direction of the instrument. Therefore, the instrument was of relatively large diameter, making gastroscopy, small bowel endoscopy and colonoscopy an uncomfortable procedure requiring sedation. Recent advances in development of low power complementary metal‐oxide silicon (CMOS) imagers, mixed signal application specific integrated circuit (ASICs) and white light emitting diodes (LEDs) made possible development of a new type of endoscope – the swallowable video capsule. We describe the development of a video‐telemetry capsule endoscope that is small enough to swallow (11×26 mm) and has no external wires, fiber optic bundles or cables. Extensive clinical and healthy volunteer trials have proved the effectiveness of the wireless endoscope in detection of pathologies in the GI tract.