Synopsis of transoral endoscopic laryngopharyngeal surgery for superficial pharyngeal cancers.

BACKGROUND: Endoscopic laryngopharyngeal surgery (ELPS) was developed for superficial pharyngeal cancers in Japan. In this study, we present our results of ELPS for superficial pharyngeal cancers. METHODS: From November 2009 to December 2015, 258 patients with superficial pharyngeal cancers underwent ELPS. Results, including survival rates, postoperative complications, and vocal function, are reviewed. RESULTS: The median follow-up period of 258 patients was 31 months. The overall and cause-specific survival rates over 3 years were 85.7% and 100%, respectively. Only 3 patients incurred local recurrences and were successfully salvaged by re-ELPS. Regarding postoperative complications, 4 patients required reoperation because of postoperative bleeding. As for the postoperative quality of life, no patients developed vocal fold paralysis. Every patient was able to consume meals at preoperative levels. CONCLUSION: ELPS is a feasible and minimally invasive treatment for superficial pharyngeal cancers with impressive quality of life results.

Efficient, effective, safe procedure to identify nonrecurrent inferior laryngeal nerve during thyroid surgery.

BACKGROUND: The nonrecurrent inferior laryngeal nerve (NRILN) is always associated with the aberrant subclavian artery. CT images can detect this vascular anomaly, which predicts an NRILN. The purpose of this study was to report our procedure to identify the NRILN in patients with the aberrant subclavian artery. METHODS: Four of 730 patients undergoing thyroid operation in our hospital were preoperatively diagnosed with aberrant subclavian artery by CT of the neck. To avoid vocal cord paralysis, we approached the vagal nerve first before dissecting the paratracheal region to discover the separation point of the NRILN from the vagal nerve. RESULTS: The NRILN was identified without difficulty in all 4 patients. No patients showed vocal cord paralysis. CONCLUSION: Approaching the vagal nerve first before dissecting the paratracheal region is an efficient, effective, and safe procedure to identify an NRILN in patients who are preoperatively diagnosed as having the aberrant subclavian artery.

Diagnostic value of ¹8F-FDG PET/CT for lymph node metastasis of esophageal squamous cell carcinoma.

PURPOSE: This study investigated the diagnostic accuracy of hybrid positron-emission tomography/computed tomography (PET/CT) for lymph node (LN) metastasis of esophageal cancer. We also investigated the correlation between the size of metastatic nests and the detection by PET/CT. METHODS: Two hundred and fifty-eight patients with esophageal squamous cell carcinoma who underwent esophagectomy with two- or three-field radical lymphadenectomy were analyzed retrospectively. We compared the diagnosis of preoperative PET/CT to the postoperative histopathological examination by each anatomical field (n = 1,231) in all 258 patients. The metastatic LNs resected from PET/CT positive fields were classified as belonging to the PET/CT-N-positive group (n = 229) and those from negative fields as belonging to the PET/CT-N-negative group (n = 352). The cross-sectional areas of metastatic nests were measured in each metastatic LN. RESULTS: Of the 1,231 fields, 275 (22 %) were positive for metastasis, including 581 LNs from 408 regional LN stations. The sensitivity and specificity of PET/CT examined by each anatomical field were 25.8 and 97.8 %, respectively. The median area of metastatic nests was 17.7 mm2 in the PET/CT-N-positive group, and 7.7 mm2 in the PET/CT-N-negative group (p < 0.001). CONCLUSIONS: A significant correlation was suggested between the nest size and detection by PET/CT. Because of its low sensitivity, PET/CT alone is insufficient to determine the surgical procedures, especially when considering reduction surgery.

Immunoglobulin G4-related disease of the heart causing aortic regurgitation and heart block.

Immunoglobulin (Ig) G4-related disease is a novel disease entity characterized by diffuse lymphoplasmacytic infiltrates and the presence of abundant IgG4-positive plasma cells in extensive fibrosis, frequently associated with tumorous swelling lesion and elevated serum IgG4 concentrations. Immunoglobulin G4-related disease has been described in almost every organ system but rarely affects the heart. We describe a rare case of IgG4-related disease of the heart causing aortic regurgitation and heart block in a 59-year-old woman. The excised lesion revealed a high ratio of IgG4-positive to IgG-positive plasma cells, providing a definite diagnosis of IgG4-related disease. The aortic valve was replaced using Manouguian technique, resulting in a favorable outcome.

Clinical impact of iodine staining for diagnosis of carcinoma in situ in the floor of mouth, and decision of adequate surgical margin.

OBJECTIVE: The use of iodine staining has been recommended for the early detection of squamous cell carcinoma (SCC) in the upper aerodigestive tract. The purpose was to verify the effectiveness of iodine staining in detecting early squamous cell carcinoma in the floor of mouth. METHODS: Between 1995 and 2005, otolaryngological examinations including the floor of mouth were performed for 2278 esophageal cancer patients as a screening program of high-risk patient group. Iodine staining was applied to a lightly reddish and/or white patch, and/or uneven lesions in the floor of the mouth. Forceps biopsy was performed for demarcated unstained or lightly stained lesions. Three patients with the tumors in the floor of mouth, which were diagnosed as more over T2 level just by visual examination, were excluded from this study. If SCC was found in the specimen, mucosal resection was performed with a safety margin of 2mm from the unstained or lightly stained lesion. The incidence, rate of carcinoma in situ, and prognosis of cancer of the floor of mouth (CFOM) were assessed. RESULTS: Iodine staining was performed for 72 of 2278 patients (3.2%) according to the presence of suspicious reddish and/or whitish and/or uneven lesions. Of these, unstained or lightly stained areas after iodine staining were recognized in 47 patients and SCC was revealed in 28 of 47 patients. The diagnosis of other 19 patients included inflammatory mucosa (n=11), low grade dysplasia (n=6), and hyperkeratosis (n=2). Sensitivity and specificity of iodine staining for detecting SCC were 100% and 59.6%, respectively. Pathological diagnosis of the 28 patients included squamous cell carcinoma in situ (n=12), microinvasive squamous cell carcinoma (n=15) disease, and focal invasive squamous cell cancer (n=1). Twenty-four of 28 patients were treated with mucosal resection without mandible resection. The other 4 patients did not receive the treatment of CFOM due to concomitant far advanced esophageal cancer. In 24 patients undergoing mucosal resection, no patients developed local recurrence or metastasis to the cervical lymph nodes during an average of 74.2 months of follow-up period (from 7 to 156 months). The 5-year cause-specific survival of these patients was 100%. CONCLUSION: The use of iodine staining as a part of otolaryngological examinations may be beneficial for the early detection of CFOM, including carcinoma in situ and micro-invasive SCC. Moreover, it would be very useful to determine an adequate surgical margin for locally mucosal resection.

Lowered postoperative ldl-c/hdl-C ratio reduces later cardiovascular events after abdominal aortic aneurysm surgery.

PURPOSE: To examine the relationship between the incidence of later cardiovascular events after abdominal aortic aneurysm (AAA) surgery and postoperative lipid levels. METHODS: Atherosclerotic risk factors including postoperative serum lipid levels were examined in 116 patients aged 70 or less undergoing an elective AAA surgery. Later cardiovascular events after AAA surgery occurred in 21 patients, including cerebral infarction (n = 4), catheter intervention or surgery for coronary artery disease (CAD) (n = 10) and other vascular disease. RESULTS: Postoperative cholesterol levels during the average follow-up period of 55.6 ± 44.3 (months) were 49.0 ± 15.7 (mg/dL) for high-density lipoprotein cholesterol (HDL-C), 97.9 ± 31.2 (mg/dL) for low-density lipoprotein cholesterol (LDL-C), which were both significantly improved compared to preoperative values (p <0.001). Cox hazard analysis indicated that preexistent CAD significantly increased in the risk for later cardiovascular events (hazard ratio 5.67; 95%CI 1.92-16.8; p = 0.002) and lowered postoperative LDL-C/HDL-C ratio <1.5 decreased in the risk after AAA surgery (hazard ratio 0.10; 95%CI 0.01-0.83; p = 0.033). Patients with postoperative LDL-C/HDL-C ratio <1.5 (n = 22) had a significantly better cardiovascular event-free rate than those with that ratio ≥1.5 (n = 94) (p = 0.014). CONCLUSION: Lowered postoperative LDL-C/HDL-C ratio <1.5 can decrease in the risk for later cardiovascular events after AAA surgery. These results may support the rationale for postoperative aggressive lipid-modifying therapy.

Deep vein thrombosis in orthopedic surgery of the lower extremities.

To prevent pulmonary embolism due to deep venous thrombosis (DVT), we have treated 611 patients undergoing orthopedic surgery of the lower extremities with our protocol including pre- and postoperative ultrasonic venous screening and anticoagulant therapy if necessary. A total of 118 patients (19.3%) developed DVT. Among demographic and clinical factors, the site of operation (knee joint surgery: odds ratio 5.17), age (>60: odds ratio 3.91), and operation time (>120 minutes: odds ratio 4.52) were identified as significant risk factors of development of DVT. One patient received an infusion of urokinase for DVT of femoral vein, but no patients developed serious postoperative bleeding or pulmonary thromboembolisms. (*English Translation of J Jpn Coll Angiol, 2010, 50: 95-100.).

Surgical ventricular restoration improves the left ventricle basal wall function using quantitative gated SPECT.

OBJECTIVE: It is not clear whether surgical ventricular restoration (SVR) or procedures approaching mitral complex for controlling functional mitral regurgitation (MR) affect the regional left ventricular wall function. The purpose of the present study was to evaluate the regional LV function after SVR using overlapping left ventriculoplasty (OLVP) using quantitative gated myocardial perfusion SPECT (QGS). PATIENTS AND METHOD: Forty-one heart failure patients, including those with ischemic cardiomyopathy (ICM) (n = 25) and non-ICM (NICM) (n = 16), underwent SVR and/or papillary muscle approximation (PMA). The rest myocardial perfusion SPECT were performed before and early after operation (mean 25.8 ± 10.6 days). These patients were divided into 4 groups based on the surgical procedures (SVR and/or PMA) and etiology of patients (ICM or NICM) as follows: SVR (with or without PMA) of ICM, SVR of NICM, PMA of ICM and PMA of NICM groups. The regional wall thickening was compared before and after the operation between the four groups. RESULTS: NYHA functional classes were improved after the operation in all four groups. MR grade was also improved in three groups other than SVR of the ICM group. The left ventricular basal wall thickening was improved postoperatively in following three groups (SVR of ICM: 12.7 ± 3.8% to 16.5 ± 4.6% p <0.05, PMA of ICM: 11.1 ± 4.3% to 14.9 ± 4.8% p <0.05, SVR of NICM: 5.8 ± 6.6% to 12.3 ± 6.4% p <0.05), whereas PMA of the NICM group did not show an improvement. Wall thickening in the middle and distal levels was not improved in all groups. CONCLUSION: OLVP improved NYHA functional classes, and also improved the regional wall function at the basal level of the left ventricle. In contrast, lone PMA did not improve or impair the regional wall function at any of the levels.

Measured tube technique for ensuring the correct length of slippery artificial chordae in mitral valvuloplasty.

Mitral valvuloplasty using Gore-Tex (W.L. Gore & Associates, Inc, Flagstaff, AZ) as artificial chordae is often associated with difficulties in determining the length of the artificial chordae, as well as preventing knot slippage, especially for patients with broad anterior leaflet prolapse. We describe a simple technique that enables surgeons to easily determine the correct length of the artificial chordae and tie slippery knots without using a specific device.

Cytokine balance in hepatosplanchnic system during thoracoabdominal aortic aneurysm repair.

While prolonged visceral ischemia seems to be a potential source of elevated proinflammatory cytokines during thoracoabdominal aortic aneurysm (TAAA) repair, the underlying mechanisms are unclear. We have investigated the production of cytokines and fatty acid binding proteins (FABPs) in the hepatosplanchnic system during TAAA repair. Arterial and hepatic venous levels of tumor necrosis factor-alpha (TNF-α), interleukin (IL) -6, -8, and -10, and liver- and intestinal-type FABPs (L-FABP, I-FABP) were measured at four time points in ten patients undergoing TAAA repair. Visceral arteries were perfused through either a side-arm of distal aortic perfusion or an individual circuit using an independent pump, or both, without measuring perfusion pressure or blood flow. The postoperative courses of all patients were uneventful. During visceral perfusion, the levels of arterial IL-6, -8, and -10, and L-FABP elevated significantly (P = 0.0077, 0.0051, 0.0077, 0.0077, respectively), and these elevated levels persisted up to skin closure, with the exception of L-FABP (P = 0.0051 each). In contrast, there were only subtle increases in TNF-α and I-FABP levels. The production ratio through the hepatosplanchnic system of TNF-α, L-FABP, and I-FABP showed a pronounced peak during visceral perfusion, but only the peak of L-FABP was significant compared with baseline (P = 0.0077). All production ratios returned to baseline level at skin closure. The production ratio of IL-6 was negative throughout the operation and that of IL-8 and IL-10 remained at baseline during visceral perfusion. In conclusion, a portion of the TNF-α, L-FABP, and I-FABP might be produced temporarily in the hepatosplanchnic system during TAAA repair. Systemic elevation of IL-6, IL-8, and IL-10 might be modulated by inflammatory response to extracorporeal circulation or surgical stress. Thus, our simple visceral perfusion techniques may indeed be justified.

Can we change the operative criteria for the MAZE procedure combined with valve surgery in the era of radiofrequency devices?

PURPOSE: After radiofrequency (RF) ablation became available, the indication of MAZE procedure conducted with bipolar RF was expanded. We examined the efficacy and feasibility of the RF MAZE procedure in valve surgery and identified the predictors of atrial fibrillation (AF) recurrence. METHODS: Forty-four patients had permanent AF at the time of operation and underwent a biatrial RF MAZE procedure. Univariate and multivariate analysis for the predictor of permanent AF recurrence and follow-up studies were performed. RESULTS: Of the patients, 37 (84.1%) were in non-AF rhythm at discharge and 25 (80.6%) were at the latest follow-up (mean, 2.1 ± 1.2 years). In stepwise multivariate analysis, left atrial dimension (LAD) > 61.5 mm was an independent predictor of early-term recurrence of AF (P = 0.006) and late-term recurrence (P = 0.038) as well. F-wave voltage <0.1 mV was significant in univariate analysis but was not significant in multivariate analysis for predictor of late-term AF recurrence. Avoidance of AF in the late term was 56% for LAD > 60 mm whereas it was 91% for LAD ≤ 60 mm (P = 0.043), 67% for F-wave < 0.1 mV compared to 100% for F-wave ≥ 0.1 mV (P = 0.031), and 43% for LAD > 60 mm and F-wave < 0.1 mV compared to 91% for LAD ≤ 60 mm and/or F-wave ≥ 0.1 mV (P = 0.016), respectively. Although avoidance of AF in the late term was lower in patients with LAD > 60 mm or F-wave < 0.1 mV, more than half of these patients were free from AF in the late term. CONCLUSION: LA size was assumed to be a simple and strong predictor of recurrent AF in this procedure. Predictive criteria that had been widely employed for the "cut-and-sew" MAZE procedure accompanied with valve surgery can be expanded in the MAZE procedure with RF devices.

Successful excision of a saphenous vein graft aneurysm with different methods.

Aneurysm of an aortocoronary saphenous vein graft (SVG) is a rare but potentially fatal complication after coronary artery bypass grafting (CABG). Prevention of cerebral infarction or myocardial infarction due to the intraluminal debris from the SVG aneurysm is an important issue during surgical procedures. We report two patients with SVG aneurysms located in the proximal and distal portions of the SVG body, respectively. The surgical strategy for each case was determined according to the location of the aneurysm. We used low-flow cardiopulmonary bypass without aortic clamping in one patient and cardiac arrest with aortic clamping in the other. Both patients were discharged without sequelae.

Predictors of cervical lymph node involvement in patients with pharyngeal carcinoma undergoing endoscopic mucosal resection.

OBJECTIVE: Although detection of pharyngeal carcinoma remaining in the epithelium or subepithelial tissue layer has been difficult by routine examinations, recent advances in endoscopic technology have enabled us to detect these lesions. These patients can receive endoscopic mucosal resection (EMR) and generally have a good prognosis, but some patients have nodal involvement. The purpose was to investigate predictors of nodal involvement in patients with pharyngeal carcinoma undergoing EMR at our hospital. STUDY DESIGN: Outcomes research. METHODS: Lymph node involvement, endoscopic morphology, and tumor thickness were investigated in 152 patients treated between 2001 and 2009. RESULTS: Pathological examination revealed carcinoma in situ (CIS) for 77 patients and subepithelial invasion (SEPI) for 75 patients. There were no patients with muscular invasion. Nodal involvement was found in none of CIS but in 7 of 75 patients (9.3%) with SEPI. In patients with SEPI, the mean tumor thickness was significantly higher in patients with lymph node involvement (1311.4 ± 300.0 µm) than those without involvement (692.6 ± 495.7 µm) (p=0.002). Significant risk factors for nodal involvement included the tumor thickness over 1000 µm (p<0.001) and the presence of venous or lymphatic invasion (p<0.05). Based on analysis in relation to sensitivity and specificity, the tumor thickness over 1000 µm may serve as the most predictive factor for nodal involvement. CONCLUSION: Tumor thickness can be a simple predictor for nodal involvement in cases of SEPI. Careful follow-up including neck palpation and annual imaging diagnostics such as computed tomography or ultrasonography are recommended for these patients.

Preoperative HDL-C Predicts Later Cardiovascular Events after Abdominal Aortic Aneurysm Surgery.

PURPOSE: To determine the predictive value of serum lipid levels on the development of later cardiovascular events after abdominal aortic aneurysm (AAA) surgery. METHODS: A total of 101 patients under 70 undergoing an elective AAA surgery were divided into the following two groups: 1) those who developed later cardiovascular events after AAA surgery, including cerebral infarction (n = 4), catheter intervention (PCI) or surgery for coronary artery disease (CAD) (n = 9) and other vascular disease. (CVE group; n = 19); 2) those without later events (NoCVE group: n = 82). Preoperative atherosclerotic risk factors including serum lipid levels were subjected to univariate and multivariate analysis. RESULTS: The CVE group showed a significantly lower high-density lipoprotein cholesterol (HDL-C) level (32.9 ± 6.6 vs 41.6 ± 12.1 mg/dL; p <0.001), higher low-density lipoprotein cholesterol (LDL-C) / HDL-C ratio (4.30 ± 1.01 vs 3.24 ± 1.15; p = 0.001), and higher prevalence of mild CAD (without an indication of PCI) (p = 0.029) preoperatively. Cox hazard analysis indicated that preexistent mild CAD (hazard ratio 4.70) and preoperative HDL-C <35 mg/dL (hazard ratio 3.07) were significant predictors for later cardiovascular events after AAA surgery. CONCLUSION: Patients at high risk for later cardiovascular events should require a careful follow-up and may also require an aggressive lipid-modifying therapy.

Optimal proportions of gelatin-resorcin-formalin components in aortic surgery.

BACKGROUND: Gelatin-resorcin-formalin (GRF) glue, a haemostatic agent often employed for aortic surgery, has beneficial effects on early results in surgery for acute aortic dissection but may have late adverse effects, probably due to excess use of the activators such as formaldehyde and glutaraldehyde. The purpose of this study was to determine the optimal proportions of GRF components that minimise toxicity to human aortic smooth muscle cells and elastin with acceptable adhesive strength. METHODS: (1) The degree of polymerisation was examined at various proportions (activator/gelatin+resorcinol=0%, 2%, 4%, 6%, 8% and 10%) to estimate adhesive strength. (2) (i) The toxicity of the activator was confirmed 24h after its supplementation to human aortic smooth muscle cells in various proportions (activator/human aortic smooth muscle cell=0%, 0.5%, 1%, 1.5%, 2% and 2.5%). (ii) The toxicity of GRF glue to human aortic smooth muscle cells was evaluated 1h and 60 h after its supplementation (activator/gelatin+resorcinol=0%, 2%, 4%, 6%, 8% and 10%). Another set of experiments in the same study was also performed. The only difference was that GRF glues were washed after polymerisation to exclude non-polymerised constituents. (3) Effects of 8%-GRF glue on toxicity to elastin derived from human aortic wall cells were investigated using an immunoblotting method. RESULTS: (1) The polymerisation area increased dose dependently and that of the 10% activator/gelatin+resorcinol mixture was significantly wider than those of 6%, 4%, 2% and 0%, but had no significant difference from that of 8%. (2) (i) Human aortic smooth muscle cell death occurred in all dishes except activator-free dishes. (ii) Sixty hours after exposure to GRF glue, human aortic smooth muscle cell death occurred only in the 10% dish. In a washed GRF glue study, no human aortic smooth muscle cell death occurred in any dishes. (3) Toxicity to elastin was not significantly different between 8%-GRF glue and the control, whereas toxicity of elastase to elastin was significantly higher than for both the glue and the control. CONCLUSIONS: An 8%-GRF glue provides lower toxicity to human aortic smooth muscle cells and elastin with an acceptable degree of polymerisation, and thus seems to be an optimal proportion for GRF glue.

The value of narrow band imaging for early detection of laryngeal cancer.

We evaluate the value of laryngoscopy using narrow band imaging (NBI) system in the diagnosis of precancerous and cancerous laryngeal lesions. Thirty-four patients were suspected of having a total of 35 precancerous or cancerous laryngeal lesions among patients receiving conventional white-light laryngoscopy. All 34 patients underwent laryngoscopy with NBI system to determine whether those lesions were malignant before biopsy procedure. The diagnostic criteria of malignancy by NBI view was the presence of demarcated brownish area with scattered brown spots in the lesion. Histopathologic results were retrospectively compared with results of determination of malignancy made by NBI view. Of the 23 lesions histopathologically proved to be malignancies, 21 lesions were classified as malignant by NBI view. Sensitivity and specificity for the diagnosis of malignancy by means of NBI view compared with histopathologic results were 91.3% for sensitivity and 91.6% for specificity. NBI endoscopy seems to be a very promising diagnostic tool in the diagnosis of laryngeal malignant disease.

Maximum aortic diameter as a simple predictor of acute type B aortic dissection.

OBJECTIVES: To identify the most prognostic predictor of Stanford type B aortic dissection at admission. PATIENTS AND METHODS: Forty-three patients with Stanford type B aortic dissection were divided into two groups: (1) those who developed dissection-related events later (EV group: n = 18), including the need for surgery (n = 12), rupture (n = 1), dissection-related death (n = 5), and aortic enlargement > or =5 mm in diameter per year (n = 15); (2) those without later events (NoEV group: n = 25). Clinical features, aortic diameters, and blood flow status were compared. RESULTS: The maximum aortic diameter at admission was 41.5 +/- 1.7 mm for the EV group, which was significantly greater than the NoEV group (34.4 +/- 0.9 mm, p <0.001). A maximum aortic diameter > or =40 mm was found in 11 patients (61%) of the EV group, whereas this maximum was found in 4 (16%) of the NoEV group (p = 0.004). A patent false lumen at admission was found in all patients of the EV group and in 17 (68%) of the NoEV group (p = 0.013). Other factors were not significant. A Cox hazard analysis indicated a maximum aortic diameter > or =40 mm as a significant predictor for dissection-related events (hazard ratio 3.13, p = 0.032). The presence of a patent false lumen did not reach a statistical significance. CONCLUSION: Our results indicated that a maximum aortic diameter > or =40 mm at admission was the most prognostic factor for developing late dissection-related events, rather than the presence of a patent false lumen.

Septal myectomy, papillary muscle resection, and mitral valve replacement for hypertrophic obstructive cardiomyopathy: a case report.

We report a case of hypertrophic obstructive cardiomyopathy (HOCM) successfully treated with septal myectomy and mitral valve replacement (MVR) combined with a resection of the hypertrophic papillary muscles. The patient, a 74-year-old woman, first underwent the conventional septal myectomy through aortotomy. The papillary muscles revealed a marked hypertrophy, but extended myectomy and precise resection of the hypertrophic papillary muscles were thought to be difficult through the aortotomy. Through the right-sided left atriotomy, MVR and resection of the papillary muscles were additionally performed. The patient was smoothly weaned from the cardiopulmonary bypass, and the postoperative course was uneventful. The outflow pressure gradient was relieved to 0 mm Hg, from 94. The mean pulmonary artery pressure was reduced to 27 mm Hg, from 42. The patient has been doing well in the New York Heart Association (NYHA) functional class between I and II during 45 months of follow-up, without complications related to the use of a prosthetic valve. Septal myectomy is the procedure of choice in the surgical treatment of HOCM for most cases, but some may require additional mitral valve procedures. In patients with marked hypertrophic papillary muscles, MVR and resection of the muscles may be an option of treatment to ensure a relief of the outflow obstruction and to abolish systolic anterior movement in units with limited experience.

The value of narrow band imaging endoscope for early head and neck cancers.

OBJECTIVES: To evaluate the diagnostic value of rhinolaryngoscopy using a narrow band imaging (NBI) system in detecting squamous cell carcinoma of the head and neck (SCCHN) in patients with esophageal cancer (EC). STUDY DESIGN: Prospective study. SUBJECTS AND METHODS: Between January 2006 and December 2006, 667 consecutive EC patients underwent rhinolaryngoscopy screening with both a white light and an NBI system. Sensitivity, specificity, accuracy, and positive/negative predictive values for detecting SCCHNs were calculated and compared. RESULTS: Forty-five patients (6.7%) of 667 patients had SCCHNs. Sensitivity, specificity, accuracy, positive predictive value, and negative predictive value for detecting SCCHNs by white light were 51.1 percent, 99.7 percent, 96.4 percent, 92 percent, and 96.6 percent. In contrast, those by NBI were 97.7 percent**, 98.9 percent, 98.8 percent*, 86.3 percent, and 99.8 percent** (*P < 0.01, **P < 0.001 vs white light). CONCLUSION: An NBI endoscope significantly improves diagnostic accuracy, sensitivity, and negative predictive value in detecting SCCHN in EC patients. This endoscope would be highly beneficial in detecting superficial SCCHNs in high-risk patients.