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.