The Diagnostic Yield of Laryngeal and Pharyngeal Pathologies During Upper Gastrointestinal Endoscopy at the Kenyatta National Hospital: A Comparison Between Indirect Laryngoscopy and Oesophagogastroduodenoscopy Findings

Abstract

Background: Evaluation of the larynx and pharynx areas is not always performed during oesophagogastroduodenoscopy(OGD) despite the oropharynx and laryngopharynx being bypassed to get to the oesophagus. Laryngopharyngeal abnormalities have been picked in up to 5.4% OGDs. Main objective: To determine the diagnostic yield of laryngeal and pharyngeal pathology during OGD at Kenyatta national hospital (KNH) Study design and setting: This was a prospective cross sectional study on patients undergoing OGD from February to July 2020 at KNH endoscopy unit. Methodology: One hundred and twenty-one patients aged 18 years and above were recruited into the study. History and physical examination including video laryngoscopy were done followed by endoscopic evaluation of the pharynx and larynx during OGD. Data management and analysis: Data was expressed as means and standard deviations. Comparison between subsites and between both endoscopic groups was done using chi-squared. Sensitivity and specificity was calculated using indirect video laryngoscopy as the gold standard. Diagnostic accuracy was obtained using receiver operating characteristics curve. A P-value of <0.05 for a 95% confidence interval was considered significant. Results Among 121 patient recruited into the study, 17.35 % had laryngeal and pharyngeal abnormalities on OGD whereas 25.61% had abnormalities on video laryngoscopy(VL).The common pathologies on video laryngoscopy were LPR (10.79%), vocal cord paralysis (8.33%) then laryngeal leukoplakia (2.49%) while vocal cord paralysis (5.69%), LPR (4.96%) ,laryngeal and oropharyngeal leukoplakia (2.49%) were common on OGD. VL had higher odds of diagnosing pathologies of the oropharynx, larynx and hypopharynx compared to OGD. The mean time taken to evaluate the larynx and pharynx was 43±20.9 seconds while OGD procedure took 237.3±106.4 seconds. OGD was 63.4% sensitive and 91.3% specific in diagnosing pathologies of the various subsites, with positive and negative predictive values of 78.9% and 83.0% respectively. Conclusion The diagnostic yield of laryngeal and pharyngeal pathologies during OGD is significant and it only requires 43 seconds to do examination. Examination of the larynx and pharynx should be made part of OGD examination and reporting.