A 59-year-old man (with a 40-year-long history of smoking) and a 53-year-old woman
were referred because of reflux symptoms, such as heartburn and regurgitation, associated
with dysphonia, chronic throat clearing and globus pharyngeus. The man had undergone
Billroth II gastrectomy 29 years previously, while the woman had a history of cholecystectomy
32 years previously.
Their symptoms prompted us to perform a preliminary evaluation of the larynx in both
patients during a magnifying upper gastrointestinal endoscopy (using a Fuji EG-485ZH
video endoscope). After local surface anesthesia with 0.4 % benoxinate hydrochloride,
and before introduction of the scope into the esophagus, careful inspection of the
larynx with the video endoscope revealed vocal cord leukoplakia and signs of chronic
laryngitis in both patients (Figure [1] and 2). Furthermore, in both patients, upper gastrointestinal endoscopy revealed signs
of esophagitis, hiatus hernia, and a large amount of bile in the stomach. Subsequently,
the ear, nose, and throat (ENT) specialist confirmed our preliminary laryngeal findings.
After vocal cord decortications, histological examination revealed moderate epithelial
dysplasia on the vocal cords in both patients. They were therefore treated with prokinetic
and acid-suppressive drugs, and a ENT follow-up program was established.
Figure 1 Laryngeal leukoplakia in a 59-year-old man as visualized during a routine upper gastrointestinal
endoscopy, using a high resolution video endoscope preset to 1.5 × magnification.
Figure 2 Nodules and leukoplakia of the posterior third of the true vocal cord in a 53-year-old
woman as visualized during upper gastrointestinal endoscopy, using a high resolution
video endoscope preset to 2.0 × magnification.
On the basis of these cases, we recommend preliminary examination of the larynx during
upper gastrointestinal video endoscopy in patients in whom a harmful biliary reflux
extending as far as the larynx is suspected. Previous cholecystectomy or gastrectomy
may constitute underlying conditions that predispose towards this type of reflux into
the esophagus as far as the larynx; in general, the barrier function of the lower
esophageal sphincter is defective [1]
[2]
[3]
[4]
[5]. A prolonged history of smoking, as in our male patient, reinforces the motive for
exploring the larynx in these patients. Further studies will be needed to investigate
the potential of routine upper gastrointestinal video endoscopy for screening patients
who may require evaluation by an ENT specialist.
2 Videos
Competing interests: None
online content including video sequences viewable at:www.thieme-connect.de/ejournals/abstract/endoscopy/doi/10.1055/s-2006-925216
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