Abstract
Objective
Otolaryngologists implement transnasal esophagoscopy (TNE) to assess esophageal pathology. Previous studies using TNE to evaluate esophageal pathology have been limited in various ways. These are largely retrospective and deal with select patient populations. There are currently no data on the prevalence of esophageal pathology in “all comers” to an otolaryngology voice center. The objectives are to assess the prevalence of esophageal pathology in this population and determine the inter-observer variability of the findings reviewed by an otolaryngologist and a gastroenterologist.
Methods
Consecutive patients with throat symptoms presenting to the voice center were asked to undergo TNE. The findings were videotaped and reviewed by an otolaryngologist and a gastroesophagologist blinded to the patients’ presenting complaint.
Results
50 patients were selected prospectively to undergo TNE. Hoarseness was the most common presenting symptom (68%). According to the gastroesophagologist, the prevalence of esophageal findings was: Barrett's esophagus (12%), esophagitis (10%), hiatal hernia (32%), and esophageal stricture (10%). The percent agreement for a normal study was 72% (kappa 0.44). The percent agreement (kappa value) for various pathologic findings are as follows: Barrett's esophagus, 86% (0.45); esophagitis, 88% (0.43); hiatal hernia, 76% (0.39); and esophageal stricture, 96% (0.73). The frequency of an exact agreement between raters was 54%. For an abnormal study, the percent agreement was 80%. The reviewers were 7.11 times more likely to agree than disagree (p = 0.002).
Conclusions
Esophageal abnormalities are common in patients presenting to a voice subspecialty clinic. An interdisciplinary approach can provide this population with complementary patient care.
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