Endoscopic screening of the upper digestive tract in patients with head and neck neoplasms

Abstract

Introduction: Esophageal and gastric cancer are among the most common causes of cancer death worldwide. Patients with head and neck neoplasms are at an increased risk of synchronous gastro-esophageal neoplasias due to shared risk factors such as smoking, alcohol consumption and Human Papillomavirus infection. Despite this correlation, few Western studies described the impact of a screening program in this population. Methods: We conducted a prospective cohort study that evaluated an endoscopic screening program of patients diagnosed with head and neck neoplasms in a tertiary reference center (Centro Hospitalar Universitário São João, Porto, Portugal), between June 2020 and December 2023. Patients were referred to a Gastroenterology consultation and esophagogastroduodenoscopy was then scheduled for screening. Results: A total of 48 patients (83.3% male, mean age 64 years) successfully underwent screening esophagogastroduodenoscopy. Gastro-esophageal neoplasias were detected in a total of 9 patients, including 6 (12.5%) esophageal neoplasias and 3 (6.3%) gastric neoplasias. Endoscopic submucosal dissection was undertaken for targeted lesions in 3 patients with esophageal lesions (n=4), achieving curative outcomes in 50% (n=2). One patient underwent additional radiotherapy and the other was submitted to esophagectomy. In the other patients with esophageal lesions, one patient not amenable to endoscopic resection was referred for chemo-radiotherapy and in two patients, surveillance was decided due to oncological progression of head and neck neoplasms. All of the 3 gastric lesions identified underwent endoscopic submucosal dissection, being curative in 66.7% (n=2). There was no evidence of recurrence or progression of gastro-esophgeal neoplasias during follow-up. Discussion/Conclusion: In conclusion, the implementation of endoscopic screening led to the identification of gastro-esophgeal neoplasias in 18.8% of patients with head and neck neoplasms, mostly discovered at an early stage, enabling curative-intent treatment.