Improved hypopharyngeal visibility and early cancer detection using the modified Killian method during esophagogastroduodenoscopy in patients at high risk of head and neck cancer.
Source: PubMed, NCBI / U.S. National Library of Medicine
Patients with a history of esophageal squamous cell carcinoma or pharyngeal cancer are at high risk of laryngopharyngeal cancers, particularly in the hypopharynx. However, adequate hypopharyngeal visualization during esophagogastroduodenoscopy is challenging because of anatomical constraints. We evaluated the utility of the Modified Killian method for hypopharyngeal visualization during esophagogastroduodenoscopy in high-risk patients. The Modified Killian method had previously been used at our institution for high-risk patients with esophageal and head and neck cancers. In this retrospective comparative study, data were collected from 45 high-risk patients who underwent pharyngeal examination using the Modified Killian method after the conventional method during a single esophagogastroduodenoscopy session. The primary endpoint was the hypopharyngeal visibility score (scale 1-5). Secondary endpoints included visibility of other pharyngeal areas, procedure time, lesion detection, and adverse events. The Modified Killian method without the Valsalva maneuver yielded higher hypopharyngeal visibility scores than the conventional method (median [interquartile range, IQR]: 2.0 [2.0-4.0] vs. 1.0 [1.0-2.0]; p < 0.001). The Modified Killian method further improved visibility (median [IQR]: 4.0 [3.0-5.0]; p < 0.001 vs. conventional). No significant differences were observed in visibility of the oropharynx or vallecula. The procedure time was longer for the Mo
Abstract
Patients with a history of esophageal squamous cell carcinoma or pharyngeal cancer are at high risk of laryngopharyngeal cancers, particularly in the hypopharynx. However, adequate hypopharyngeal visualization during esophagogastroduodenoscopy is challenging because of anatomical constraints. We evaluated the utility of the Modified Killian method for hypopharyngeal visualization during esophagogastroduodenoscopy in high-risk patients. The Modified Killian method had previously been used at our institution for high-risk patients with esophageal and head and neck cancers. In this retrospective comparative study, data were collected from 45 high-risk patients who underwent pharyngeal examination using the Modified Killian method after the conventional method during a single esophagogastroduodenoscopy session. The primary endpoint was the hypopharyngeal visibility score (scale 1-5). Secondary endpoints included visibility of other pharyngeal areas, procedure time, lesion detection, and adverse events. The Modified Killian method without the Valsalva maneuver yielded higher hypopharyngeal visibility scores than the conventional method (median [interquartile range, IQR]: 2.0 [2.0-4.0] vs. 1.0 [1.0-2.0]; p < 0.001). The Modified Killian method further improved visibility (median [IQR]: 4.0 [3.0-5.0]; p < 0.001 vs. conventional). No significant differences were observed in visibility of the oropharynx or vallecula. The procedure time was longer for the Modified Killian method (237 vs. 134 s; p < 0.001). Three intraepithelial hypopharyngeal carcinomas missed by the conventional method were detected with the Modified Killian method. No adverse events occurred. The Modified Killian method, particularly its positional component alone, improves hypopharynx visualization and may contribute to early cancer detection without compromising observation of other pharyngeal areas.