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Laryngeal Visualization During Upper GI Endoscopy Increases Diagnostic Yield in Patients with Gastroesophageal Reflux (GER)

MOHAMMAD FARIVAR and JAMES KOLTON, DEPT of MEDICINE and DEPT of PATHOLOGY, NORWOOD HOSPITAL, NORWOOD, MA

Upper GI endoscopy (EGD) is negative in more than 50% of patients suffering from significant heartburn and regurgitation (H&R). During EGD, we have observed posterior vocal cord erythema, intra-arytenoid erythema and edema (mild reflux laryngitis [RL]) in the majority of patients with GER. To further define this, in 176 consecutive patients (70 male, 106 female) undergoing diagnostic EGD, the larynx was carefully observed (laryngo-EGD [LEGD]) for evidence of RL. In addition, four endoscopic pinch biopsies were taken within 2-4 cm from the gastroesophageal junction to look for microscopic evidence of chronic esophagitis.

Results: In 21 patients with only H&R, 8 (38%) had endoscopic esophagitis (grades I-III), 19 (90%) RL, and 18 (86%) had evidence on biopsy of chronic esophagitis. In a total of 77 patients with H&R and other GERD symptoms, 26 (34%) had erosive esophagitis, 69 (90%) RL, and 64 (83%) positive biopsies.

Conclusions: In patients with H&R undergoing EGD: 1. laryngeal visualization for evidence of RL (LEGD) increased the diagnostic yield of EGD from 34% to 90%; 2. The addition of distal esophageal biopsies during EGD also increased the yield of EGD to 86%; 3. To increase diagnostic yield and save costs, biopsies should be taken only if LEGD is negative for RL.

 

 

 

 

 

         This is an educational site created by M. Farivar, M.D. The information provided is the author's opinion based on years of clinical experience and research.  You are advised to consult your own physician about the applicability of this information to your particular needs.  Also, keep in mind that symptom response to therapy does not preclude the presence of more serious conditions. 

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