Panendoscopy

Panendoscopy

Panendoscopy is a panopticos endoscopic evaluation of the upper aerodigestive tract. It enables physicians to look at several sites without changing instrumentation during the pass.

What is Panendoscopy?

The surgeon performs panendoscopy to look at:

• Oropharynx
• Larynx (voice box)
• Hypopharynx
• Esophagus
• Trachea and bronchi (if the bronchoscopy is performed)

It is typically performed under general anaesthesia and is frequently employed in the evaluation, biopsy, and staging of head & neck malignancies.

Indications (When It Is Done)

Suspected or Confirmed Head & Neck Cancer

• To identify the primary tumor when hidden
• To identify second primary tumors
• Invasive Cancer Invasive cancer detail To examine how far cancer has spread

For Symptoms

• Persistent hoarseness
• Trouble swallowing
• Chronic cough
• Bleeding from throat of unknown cause
• Airway obstruction symptoms
• Diagnostic Purpose
• Suspicious lesions biopsy
• Investigation of FB
• Pre-operative evaluation

Types of Scopes

Panendoscopy generally includes:

Laryngoscopy

• Reviews larynx & vocal folds.

Esophagoscopy

• Checks the esophagus to the stomach's entry.

Bronchoscopy (optional but common)

• You need your trachea and bronchi ‌checked.

Benefits 

• Complete examination 
• Comprehensive and accurate cancer staging 
• Detection of multiple lesions 
• Perform to have tissue biopsy 
• Help to plan treatment (Surgery/Radiation/ Chemotherapy) 

Panendoscopy procedure

Panendeoscopy, also known as triple endoscopy, is a combined endoscopic procedure that examines the larynx, pharynx, esophagus, and occasionally the trachea and bronchi. It is mainly for working up head & neck cancer, symptoms, taking biopsies.

Before the Procedure (Preparation)

Evaluation of the Patient

• Medical history and physical.
• Blood tests & imaging (CT/MRI/PET in case of suspicion of cancer)
• Assessment of the airway
• Consent and the risks understand

Fasting

• Nothing to eat or drink for 6 to 8 h before the procedure.

Drugs    

• Blood thinners may have to be suspended
• Take your essential medications with a small sip of water

Anaesthesia

• It is done under general anaesthesia.
• The patient is generally placed in the Boyce position (head elevated and neck extended). 

Procedure

Step 1: Laryngoscopy

• A rigid laryngoscope is introduced through the mouth.

Inspection of:

• Oropharynx
• Hypopharynx
• Larynx (vocal  cords)
• Suspicious patches of skin are photographed and biopsied.

Step 2: Esophagoscopy

• A rigid or flexible esophagoscope passes through the hypopharynx into the esophagus.

The surgeon inspects the:

• Upper esophagus
• Mid and lower esophagus
• If there are lesions, they're biopsied.

Step 3: Bronchoscopy (if included)

• A rigid bronchoscope is introduced into the trachea.

Inspection of:

• Trachea
• Right & left bronchi
• To identify alert airway abnormalities or second primaries tumors. 

Step 4: Biopsy / Procedure

• Biopsy samples are taken from all suspicious areas found.

Can also remove:

• Foreign bodies
• Polyps
• Early small lesions

Step 5: Completion

• All scopes removed carefully.
• Before the patient is awakened, the airway is evaluated.

Duration

• Full procedure duration: 30–60 minutes
• It may last a bit longer if several biopsies are taken.

After the Procedure (Recovery)

Immediate Recovery

• Patient is monitored for 1 to 2 hours.
• Mild sore throat, hoarseness or cough is normal.

Diet

• Clear liquids once awake
• Regular diet usually next day.

Activity

• Usual activities next day
• Due to numbness of the throat, do not drink hot liquids immediately after the procedure.

Panendoscopy synchronous tumors

Panendoscopy, also known as triple endoscopy, is the cornerstone of evaluation of the entire UADT. Detection of synchronous tumors—especially in head and neck cancer patients—is one of its most important applications.

What Are Synchronous Tumors?

• Synchronous tumors refer to the presence of additional primary cancers at the same time as the initial (index) tumor.
• They are different from metastasis and develop independently as a result shared carcinogenic exposures.

Why panendoscopy for detection of synchronous tumors?

Panendoscopy permits: direct inspection of

• Oral cavity
• Oropharynx
• Larynx
• Hypopharynx
• Esophagus
• Trachea and main bronchi

This panoramic view facilitates the detection of second primaries in sites of habitual field cancerization.

Panendoscopy for screening of synchronous lesions in the esophagus

What is the surgeon looking for during the procedure?

• Subtle mucosal changes
• Leukoplakia or leukoplakia.
• Ulcers
• Submucosal lesions
• Suspicious nodules in the esophagus or bronchus

Biopsy

• A biopsy is taken of any abnormal site to determine whether it represents a separate primary tumor.

Panendoscopy preparation recovery

Panendoscopy is a method of instrumental examination of the upper digestive tract that is widely applied in the workup of head & neck cancers and for obtaining biopsies and assessing the airway.

Panendoscopy Recovery

Immediate Recovery (First 1–2 Hours)

• In the recovery room for monitoring stable breathing and vital signs
• Mild sore throat or hoarseness, cough, and dry mouth are common
• Mild expected symptoms Small amount of blood-tinged saliva may be seen if biopsies are taken

Diet After the Procedure

• Begin clear liquids when fully awake
• Under normal circumstances, eat the regular food next day as your appetite allows.
• A few hours after the procedure, avoid hot drinks because you could get burned in your numb throat.

Activity

• Rest for rest of the day.
• You can normally resume your activities on the following day.
• Refrain from intense exercise for the next 24 hours.

Voice Care

• Subtle hoarseness is not unusual
• Do not yell or whisper (they both stress your vocal chords)
• Drink enough water

Expected Mild Symptoms

• Sore throat 1-2 days
• Mild dysphagia
• Minor chest or throat irritation

Panendoscopy complications

Panendoscopy is a safe and well-tolerated procedure of diagnostic benefit in most cases. Then again, as with any endoscopic, as well as anaesthetic procedure, it does have its hazards. It is rare of complications but a sort of awareness is needed to patients and clinicians alike.

Common & Minor Complications

• Sore Throat
• Hoarseness or Voice Change
• Mouth or Lip Discomfort
• Small Amount of Blood in Saliva

Moderate Complications (Less Common)

• Dental Injury
• Bleeding
• Local Swelling
• Nausea & Vomiting

Rare but Serious Complications

• Airway Compromise
• Esophageal Perforation
• Tracheal or Bronchial Injury
• Aspiration
• Infection
• Anaesthesia-Related Complications

Best hospital for panendoscopy India

• Artemis Hospital, Gurgaon
• Medanta-The Medicity, Gurgaon
• Fortis Memorial Research Institute, Gurgaon
• Max Hospital, Saket

Conclusion

Panendoscopy (or PES) is a thorough, yet safe, diagnostic technique for examining the entire upper aerodigestive system and has proven to be useful in the clinical setting. It provides the opportunity to directly observe and take biopsies from the larynx, pharynx, esophagus, as well as the airway in one sitting, and it is also a key tool to identify primary and synchronous tumors, to evaluate the extent of disease and to plan treatment. The risks are still low and most patients recover quickly with good preparation, experienced technique, and close post-procedure attention. Panendoscopy is an indispensable tool in the early diagnosis, accurate staging of cancers, and ameliorating outcomes in patients.

Panendoscopy procedure India GetWellGo

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• Support during and after treatment. 
• Language Support
• Travel and Accommodation Services
• Case manager assigned to every patient to provide seamless support in and out of the hospital like appointment booking
• Local SIM Cards
• Currency Exchange
• Arranging Patient’s local food

FAQ

Do I have to fast for the procedure?

• Yes. No food or drink for 6 - 8 hours prior to the procedure to allow for safe administration of anaesthesia.

Am I able to speak after the procedure?

• Yes, but you may have mild hoarseness or sore throat for 1 to 2 days.

How long until I can eat after panendoscopy?

• You may begin eating small amounts of clear liquids as soon as you are fully awake and resume your normal diet the next day.

Will anything be removed during the panendoscopy?

• Yes, if the doctor identifies an area of concern they will take a biopsy at the same time.

How long until I get results for biopsy?

• The result of biopsy usually takes 3 to 7 days depending on the pathology laboratory. 

Is panendoscopy different from endoscopy?

• Yes. Panendoscopy is a procedure to examine the (larynx, pharynx, esophagus, and airway), whereas upper endoscopy is most commonly performed only to explore the esophagus and stomach.