gms | German Medical Science

GMS Current Posters in Otorhinolaryngology - Head and Neck Surgery

German Society of Oto-Rhino-Laryngology, Head and Neck Surgery (DGHNOKHC)

ISSN 1865-1038

Somnooesophagoskopie III - Der HNO-Arzt als Torwächter des Aerodigestivtraktes

Somno-esophagoscopy III – the ENT-specialist, doorkeeper of aerodigestive tract

Poster Aerodigestivtrakt

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GMS Curr Posters Otorhinolaryngol Head Neck Surg 2016;12:Doc055

doi: 10.3205/cpo001406, urn:nbn:de:0183-cpo0014063

Published: April 11, 2016

© 2016 Schedler.
This is an Open Access article distributed under the terms of the Creative Commons Attribution 4.0 License. See license information at http://creativecommons.org/licenses/by/4.0/.


Outline

Abstract

Videosomno-esophagoscopy (VSES) is an endoscopic approach to understand and visualize the effects of thoracic pressure changes on the upper digestive tract during obstructive breathing. We conducted 376 VSES in our unit. 301 of them had been carried out after Videosomnoscopy(VSS), using a 4.9 mm children gastroscope to perform both procedures. We found, especially in OSA patients with reflux symptoms, in almost all cases a more or lesser pronounced invagination of cardial and fundus mucosa into terminal esophagus, indicating a major role of supraglottic obstruction (SGO) in development of axial hernia. In addition, we found that invagination was more pronounced in patients with SGO on epiglottis level, than other obstruction levels, like soft palate or base of tongue. When obstruction suspends, the invagination will suspend also. In 3 cases obstruction induced invagination was associated with spontaneous regurgitation/emesis up to 8 times/day. All 3 patients were diagnosed for SGO on epiglottis level and received Laser-epiglottis partial resection. Emesis disappeared completely in 2 cases and subtotally in 1 case. After VSS, VSES can also be carried out using a thicker (max 8mm) gastroscope, but the width of the instrument may impair results by altering position of larynx, thereby reducing or increasing obstruction on supraglottic level, since the instrument cannot be inserted transnasally, but only via oropharyngeal route. Use of a low diameter, nasogastrally insertable, endoscope is recommended. Our team is on way to develop a low diameter Somnoesophagocope as a new tool to further elucidate the interactions between OSA/UARS and reflux diseases of upper digestive tract. The ENT-specialist is able to perform, as well VSS as VSES and thus could be the doorkeeper of aerodigestive tract.

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