Reintroducing otolaryngologists to esophageal disease.

In this issue, we introduce an exciting new department: ESOPHAGOSCOPY CLINIC (page 438). This addition to our popular CLINIC series of practical, hands-on tips will concentrate on the use of new technology in the management of esophageal problems. We think it will serve as a starting point from which otolaryngologists can begin to expand our expertise.

From the turn of the 19th century, through the era of Chevalier Jackson, and up until the mid-1960s, the esophagus was the exclusive domain of the otolaryngologist. However, after the advent of the flexible fiberoptic esophagoscope, much of esophagology became the province of the gastroenterologist.

During the 1990s, laryngopharyngeal reflux (LPR) became a hot area of laryngology. LPR differs in many ways from classic gastroesophageal reflux disease, and gastroenterologists in general do not understand LPR. Yet we still refer our patients to them for esophageal endoscopy. Why?

It is now possible for the otolaryngologist to perform comprehensive in-office transnasal esophageal examinations without the need for intravenous or oral sedation or anesthesia. The esophagoscope that we use at Wake Forest University has an external diameter of only 5.1 mm, and it is equipped with a distal chip camera that provides excellent images. In addition to allowing us to perform air insufflation and irrigation, this instrument has another working channel that allows us to take biopsy specimens from the laryngopharynx and esophagus. Of course, this same instrument can be used to examine the laryngopharynx and the tracheobronchial tree. It is a powerful, multipotential panendoscopic tool.

The primary purpose of ESOPHAGOSCOPY CLINIC is to begin the process of re-educating otolaryngologists about diseases of the esophagus. We hope that in the years ahead, the techniques we discuss will proliferate widely throughout our specialty.