Symptom-directed selective endoscopy - Long-term efficacy

Background: Synchronous primary neoplasms have been encountered in some pat ients with mucosal squamous cell carcinoma of the head and neck. Routine pa nendoscopy along with various radiological tests have been advocated to ide ntify these potential tumors. In 1993, we originally described symptom-dire cted, selective endoscopy as an efficient and cost-effective means to evalu ate patients to identify synchronous primary neoplasms. Objective: To review the ultimate success rate of symptom-directed, selecti ve endoscopy in that initial cohort of patients and the success of the prog ram longitudinally in clinical practice over the intervening 6 years. Patients and Methods: The status of the original 100 patients who participa ted in the selective endoscopy study were reviewed at least 6 months after the original procedure. A statistically significant random sample of 101 su bsequent patients who had at least 6 months' follow iv-up or until their de ath were reviewed. Results: No additional primary, mucosal head and neck, esophageal, or pulmo nary cancers were identified in the surviving original cohort of patients s uggesting that the selective endoscopy identified all synchronous tumors. S ixteen metachronous primary cancers were identified between 12 and 70 month s after the initital evaluation. Eight synchronous primary cancers were ide ntified in the new cohort using symptom-directed evaluation, direct laryngo pharyngoscopy, and chest x-ray films. No additional tumors were detected wi thin 6 months. Conclusion: Symptom-directed, selective endoscopy seems to be an effective alternative to routine panendoscopy in identifying synchronous primary canc ers.