Thinner tube eases throat exams

Thinner is better - or at least more hassle-free.

That applies especially when snaking tubes, video cameras and tiny biopsy pincers down someone's throat to check out the esophagus and stomach.

A thinner tube means no sedation.

That means shorter exams with no need for a groggy patient to need a driver afterwards.

Kalispell Gastroenterology has been using a thinner videoendoscope for the past two months, with its doctors hoping that easier use will lead to more patients getting early detection for the likelihood of getting cancer in the throat.

An endoscope is a thin tube that is gently pushed through the mouth or a nostril to crawl down the esophagus, capable of reaching the stomach.

The tube contains fiberoptics and tiny cables to shine a light in the esophagus, transmit video images to a doctor, twist and turn the light and video camera, and insert equipment capable of extracting a biopsy sample from inside the throat and stomach.

It is a way to check out the esophagus for damage from acid reflux - stomach acids churned back up the throat.

About 20 percent of adults suffer from acid reflux problems, said Dr. Robert Yacavone, a physician at Kalispell Gastroenterology.

And 6 to 12 percent of those acid reflux suffers end up with their throats in a damaged condition that could lead to esophageal cancer.

Esophageal cancer has increased 350 percent in the past 30 years, according to the American Journal of Gastroenterology.

That's due to a combination of people eating more acid-causing foods and people weighing more, which affects the structural dynamics at the bottom of the stomach, Yacavone said.

Consequently, tracking acid reflux damage inside the esophagus is a way to get an early warning of the likelihood of throat cancer.

A problem with conventional videoendoscopes used for this detection is that they are 9.8 millimeters in diameter. That's 0.392 inch, or the diameter of a ring finger.

"That's a lot to swallow," Yacavone said.

A patient needs to be sedated to handle such a tube being nudged down his or her throat.

That translates to longer pre-examination sessions, intravenous tubes during the exams, more monitoring equipment, more time after an exam to recover, and the requirement for someone to drive a groggy patient home.

The extra time and equipment lead to extra expenses for the medical practice and patients.

The newer videoendoscope's tube is 4.9 millimeters in diameter - half of the older model's width.

A study in 2003 and 2004 at the Oregon Health and Science University used both the 9.8-millimeter and 4.9-millimeter videoendoscope on 121 patients.

A 2006 American Journal of Gastroenterology article on the study said that the two endoscopes detected pre-cancerous conditions and other problems with the same degree of accuracy.

The study said 71 percent of the tested patients preferred the unsedated exams with the thinner tubes.

Yacavone said that means gastroenterologists can shorten lengthy exams to an office visit of 20 to 25 minutes with no sedation, intravenous tubes or the need for patients to obtain drivers.

He said: "We feel this can open up this procedure to a larger number of patients."

Reporter John Stang may be reached at 758-4429 or by e-mail at jstang@dailyinterlake.com