Enhanced contact endoscopy allows for predicting histologic changes of laryngeal and hypopharyngeal lesions from inflammation to cancer on based on fine evaluation of the neoangiogenetic changes of the chorion. This innovative procedure can be considered an important tool during diagnosis, treatment, and follow-up of patients with precancer and cancer of the larynx and hypopharynx.

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Sebbene le tecniche scialoendoscopiche abbiano assunto un ruolo fondamentale nel trattamento delle patologie ostruttive dei dotti salivari, in letteratura sono riportati pochi studi multicentrici sull’argomento. Questo studio basato sull’esperienza di 9 centri italiani è stato condotto su 1152 pazienti (553 donne, età media di 50 anni) per un totale di 1342 procedure scialoendoscopiche, il 44,6% delle quali a carico della ghiandola parotide. Il 12% dei pazienti è stato sottoposto a più interventi. I calcoli salivari sono risultati essere la principale causa di ostruzione (55%), seguiti dalle stenosi e altre malformazioni duttali (16%), dai tappi mucosi (14,5%) e dalla scialodochite (4,7%). La procedura endoscopica è stata portata a termine in 1309 casi mentre in 33 casi è stata interrotta, principalmente a causa della presenza di stenosi duttali complete (21 casi). Dopo una o più procedure il successo terapeutico è stato ottenuto nel 92,5% dei pazienti. Complicanze peri-operatorie e post-operatorie sono state riscontrate nel 5,4% dei casi trattati. La scialoendoscopia rappresenta quindi una procedura efficace e sicura nella diagnosi e nel trattamento delle principali patologie ostruttive dei dotti salivari.

Dysplasia and squamous cell carcinoma of the upper aerodigestive tract show significant neoangiogenesis appearing as subepithelial and epithelial microvascular irregularities that can be detected by Image-Enhanced Endoscopy such as Narrow Band Imaging and Storz Professional Image Enhancement System. In the present study, the most advanced endoscopic enhancement systems were coupled with Contact Endoscopy (Enhanced Contact Endoscopy). This original method improved the identification and the understanding of the neoangiogenetic changes of the chorion in 42 patients with leukoplakia, erythroplakia, and leuko-erythroplakia of the oral cavity and oropharynx. The physiologic and pathologic mucosa was described in five obvious vascular patterns observed at Enhanced Contact Endoscopy ranging from normal to squamous cell carcinoma, passing through inflammation, hyperplasia, and dysplasia. Each vascular pattern was then compared to histology, showing that the microvascular architectural changes seen with Enhanced Contact Endoscopy are almost constant. Sensitivity, specificity, positive predictive value, and negative predictive value in the differentiation between healthy mucosa and inflammation versus pathologic hyperplasia, dysplasia, and carcinoma were, respectively, 96.6, 93.3, 98.2, 87.5, and 95.9 %. Sensitivity and specificity were 100 % in differentiation between non-malignant lesions versus squamous cell carcinoma. Our preliminary experience shows that accuracy of Image-Enhanced Endoscopy in the diagnosis of precancerous lesions and squamous cell carcinoma of the oral cavity and oropharynx can be increased if associated to Contact Endoscopy.

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