A soft hood improves maneuverability in narrow spaces during pharyngeal endoscopic submucosal dissection

Endoscopic submucosal dissection (ESD) is a minimally invasive treatment for superficial pharyngeal cancer [1]. However, maneuvering the scope is more difficult in working spaces that are narrowed by anatomical features, such as the larynx and thyroid cartilage, or by equipment, such as intubation tubes, laryngoscopes, and grasping forceps. Transparent hoods are widely used for ESD in all gastrointestinal sections to secure the visual field and provide traction, but their long tips and larger outer diameters can obstruct surrounding structures during a pharyngeal ESD. We therefore used a soft, bendable transparent hood (Space adjuster; TOP Corporation, Tokyo, Japan) for pharyngeal ESDs to improve maneuverability in tight working spaces ([Video 1]).

Video 1 A soft hood that bends in narrow working spaces improves endoscope maneuverability.

Case 1

An 18-mm lesion was located at the left pyriform sinus ([Fig. 1 a]). As its oral edge (red arrowhead) was close to an aryepiglottic fold, we were concerned about intrusion by the intubation tube during the incision. We therefore used a soft hood, which bent with its surroundings, thus reducing interference with the intubation tube ([Fig. 1 b]).

Fig. 1 Case 1: an 18-mm lesion on the left pyriform sinus. a Endoscopic image of narrow-band imaging (arrowheads: lesions). Oral edge of this lesion (red arrowhead) was close to an aryepiglottic fold. b Endoscopic image during endoscopic submucosal dissection. The soft hood bent.

Case 2

Three small lesions (5 to 8 mm) that were located at the left pyriform sinus ([Fig. 2 a]) were resected en bloc. We used a soft hood to avoid occluding the larynx and blocking the grasping forceps during ESD ([Fig. 2 b]).

Fig. 2 Case 2: the lesions on the left pyriform sinus. a Endoscopic image of white-light endoscopy. Three small lesions (5 to 8 mm) are marked. b Endoscopic image during endoscopic submucosal dissection. A soft hood bent.

In conclusion, these procedures were stably performed, even in narrow working spaces, using a soft hood during pharyngeal ESD.

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• Reference

• 1 Hanaoka N, Ishihara R, Takeuchi Y. et al. Endoscopic submucosal dissection as minimally invasive treatment for superficial pharyngeal cancer: a phase II study (with video). Gastrointest Endosc 2015; 82: 1002-1008