Transnasal esophagoscopy: state of the art.

The purpose of this article is to trace the evolution of esophagoscopy from its inception over 100 years ago to its current state of the art. In so doing, the positive consequences that will likely result because of the transition from rigid, per oral, sedated esophagoscopy to flexible, transnasal, unsedated esophagoscopy will be described. Several of the seminal advances in esophagoscopy over the past century were the result of innovations by otolaryngologists. Until 10 years ago, the esophagoscopy performed by otolaryngologists had primarily been a rigid, transoral approach performed with the patient under general anesthesia or under intravenous sedation with local anesthesia. However, beginning in the mid 1990s otolaryngologists began to perform esophagoscopy utilizing an ultra thin, flexible scope passed transnasally, with the patient not sedated, solely relying on topical anesthesia. This approach, called Transnasal esophagoscopy (TNE), will ultimately be found to have the following advantages over traditional, peroral, rigid, or flexible esophagoscopy carried out in a sedated patient: 1) enhanced patient safety; 2) improved survival of esophageal adenocarcinoma; 3) increased practice efficiency. Within a short time TNE will be the primary manner in which the esophagus is examined by clinicians. It will be up to the otolaryngology community at large to apply the same levels of expertise that currently exist with respect to laryngeal disease to esophageal disease.