Is Same-Day Discharge Suitable following Rigid Esophagoscopy? Findings in a Series of 655 Cases

Abstract

It has been suggested that more otolaryngologic procedures should be performed on an outpatient basis, and that rigid upper aerodigestive tract endoscopy might be a particularly suitable procedure in this regard. To determine ifthis is indeed the case, we retrospectively reviewed the records of563 patients who had undergone 655 rigid esophagoscopies in our unit between Jan I, 1991, and July 31, 1998. We ascertained the rate of compli cations (primarily esophageal perforation) following such procedures and, when they did occur, we determined the length of time between surgery and the onset of the complications ' signs and symptoms. Our aims were to establish the minimum duration of postoperative observation that is required followin g esophagoscopy and to propose criteria for safe same-day discharge. We found that perforation rates were 4.5% following therapeutic procedures (dilation, biopsy, andforeign-body removal) and I.2 %following diagnostic pro cedures. In 40 % ofthe patients who experienced perforations, no such signs or symptoms were noted within the first 8 hours following surgery. This f inding has important implications for surgeons who wish to perform rigid esophagoscopy on an outpatient basis.

Role of panendoscopy to identify synchronous second primary malignancies in patients with oral cavity and oropharyngeal squamous cell carcinoma

“…The decision to perform any screening procedure involves weighing the likelihood of both identifying a lesion that would otherwise remain undetected as well as the potential improved treatment outcome achieved through early identification versus the risks of the procedure. Although the reported risks of flexible bronchoscopy and esophagoscopy are minimal (no mortality; 0.8% vs 0% complication rates, respectively),18–20 rigid esophagoscopy, which continues to be performed by many head and neck surgeons, carries a reported 1.2% esophageal perforation rate when performed as a diagnostic procedure 21. In our study, no complications related to any portion of the panendoscopy procedure occurred.…”

Is inpatient admission necessary following removal of airway foreign bodies?

“…However, rigid esophagoscopy is not without serious risk. In a review of 655 rigid esophagoscopies with intervention the rate of esophageal perforation is 4.5% [9]. Most concerning, 40% of patients with perforation demonstrate no symptoms within the first 8 h and would have been discharged prior to any signs or symptoms.…”

Outpatient surgical practices in otorhinolaryngology

“…[7] Bunun yanında ofis bazlı trakeoskopi, bronkoskopi, özofagoskopi ve larengeal enjeksiyon gibi işlemler de yapılabilmektedir. [8,9] Günümüzde bazı gelişmiş ülkelerde, tiroidektomi veya uvulopalatofarengoplasti gibi daha kapsamlı cerrahi girişimler bile uygun hastalarda günübirlik olarak uygulanabilmektedir. [10][11][12] Amerika Birleşik Devletleri'nde uygulanan tüm günübirlik cerrahi girişimlerde KBB'nin payı yaklaşık %7.5'dir.…”