Esophageal carcinoma discovered during evaluation of food impaction. (Esophagoscopy Clinic).

A 59-year-old man complained of several days of severe, progressive dysphagia, including an inability to ingest liquids. The patient underwent barium esophagography, which demonstrated a complete obstruction. Rigid esophagoscopy was attempted but could not be performed because of the limited degree of passive cervical spine extension and cervical osteophytes.

Subsequent transnasal esophagoscopy (TNE) in the clinic allowed for directed suctioning of residual barium and secretions and revealed a significant food impaction in the midesophagus (figure, A). The impaction was carefully bypassed, which allowed for visualization of a distal, near-circumferential obstructing lesion (figure, B). Biopsies were obtained via the TNE scope, which was subsequently passed into the normal distal esophagus and gastric antrum. Then the impacted food was gently pushed distally beyond the lesion and into the stomach under direct vision. Biopsies of the obstruction revealed a squamous cell carcinoma.

Food impaction, particularly recurrent episodes, should alert the clinician to the possibility of an obstructing esophageal lesion (e.g., a mass or stricture) and merits further evaluation. TNE allows for direct examination of the esophageal lumen and identification of the etiology. It also provides a means for possible disimpaction if the distal esophagus and antrum can be examined and patency verified.

From the Center for Voice Disorders, Department of Otolaryngology, Wake Forest University Medical Center, Winston-Salem, N.C.; www.thevoicecenter.org