Like the stomach and duodenum, the pharynx and esophagus also have areas that are easy to miss. First of all, the pharynx is not visible unless you look at it consciously, so the observation method becomes a problem. In other words, observation of the junction of the cervical esophagus and the gastric esophagus requires a lot of attention. In addition, the anterior side of the entire esophagus is an area that is easily missed and should be observed consciously. The case below is actually a 12mm LPM case, do you find it difficult to detect? Then what is the correct observation orientation and precautions? …… 2. Notes on observation of the pharynx This is a case of an 80-year-old male. Because of the presence of heterochronic multiple carcinoma, EMR/ESD was performed several times, and the lesion was thought to be well removed at that time. However, 6 weeks after the ESD was performed, when endoscopy was performed as a follow-up, a very obvious neoplastic lesion was found on the lingual surface of the epiglottis, which was a progressive cancer. Continued observation revealed that an ulcer had developed. The reason for such a missed diagnosis is that it appears that observation of the tongue surface has been performed, but in fact it is not adequate. This is explained in the context of the anatomy …… How to detect lesions more accurately Regarding the prevention of missed diagnoses, the above is an explanation of how to observe the lesion area, and the next is a fundamental explanation of how to prevent missed diagnoses more effectively at the stage of lesion detection. One of the important tools is NBI observation. The figure below shows an endoscopic image with non-magnified NBI. A large pharyngeal carcinoma is present in the teal portion. After switching from white light to NBI, the presence of the lesion becomes very visible. Also, regarding the iodine staining of the esophagus. Esophageal cancer can be observed in the lower white light image. The main point to detect esophageal cancer in the white light state is that the dendritic vessels disappear or become indistinct, and if there are such and such places, there is some kind of abnormality. In this case, after spraying iodine, anyone can find out that there is a lesion. Then, after spraying iodine, whether it is cancer or whether it is an intraepithelial tumor is easy to doubt in the diagnosis of some cases …… Focused observation in high-risk groups As with the stomach, it is important to implement efficient early esophageal cancer screening based on risk factors. However, unlike gastric and colon cancers, there are no easy risk markers for esophageal cancer. What is important here is the past history, which is used to find out whether the amount of alcohol consumed is high, whether one flushes after drinking (flusher), and whether one smokes. If these conditions occur frequently, the risk of esophageal cancer becomes higher and needs to be noticed and observed in the esophagus, and if necessary, iodine spraying is needed. Finally, Prof. Beyse analyzed the reasons for the emergence of people at high risk of flusher after drinking alcohol …… 1. Points to note for esophageal observation Like the stomach and duodenum parts, there are areas of the pharynx and esophagus that are easily missed. First of all, the pharynx is not visible unless you look at it consciously, so the observation method becomes a problem, and it is easy to miss the diagnosis at the physiological narrowing of the esophagus. In other words, observation of the junction of the cervical esophagus and the gastric esophagus requires a lot of attention. In addition, the anterior side of the entire esophagus is an area that is easily missed and should be observed consciously. The case below is actually a 12mm LPM case, do you find it difficult to detect? Then what is the correct observation orientation and precautions? …… 2. Notes on observation of the pharynx This is a case of an 80-year-old male. Because of the presence of heterochronic multiple carcinoma, EMR/ESD was performed several times, and the lesion was thought to be well removed at that time. However, 6 weeks after the ESD was performed, when endoscopy was performed as a follow-up, a very obvious neoplastic lesion was found on the lingual surface of the epiglottis, which was a progressive cancer. Continued observation revealed that an ulcer had developed. The reason for such a missed diagnosis is that it appears that observation of the tongue surface has been performed, but in fact it is not adequate. This is explained in the context of the anatomy …… How to detect lesions more accurately Regarding the prevention of missed diagnoses, the above is an explanation of how to observe the lesion area, and the next is a fundamental explanation of how to prevent missed diagnoses more effectively at the stage of lesion detection. One of the important tools is NBI observation. The figure below shows an endoscopic image with non-magnified NBI. A large pharyngeal carcinoma is present in the teal portion. After switching from white light to NBI, the presence of the lesion becomes very visible. Also, regarding the iodine staining of the esophagus. Esophageal cancer can be observed in the lower white light image. The main point to detect esophageal cancer in the white light state is that the dendritic vessels disappear or become indistinct, and if there are such and such places, there is some kind of abnormality. In this case, after spraying iodine, anyone can find out that there is a lesion. Then, after spraying iodine, whether it is cancer or whether it is an intraepithelial tumor is easy to doubt in the diagnosis of some cases …… Focused observation in high-risk groups As with the stomach, it is important to implement efficient early esophageal cancer screening based on risk factors. However, unlike gastric and colon cancers, there are no easy risk markers for esophageal cancer. What is important here is the past history, which is used to find out whether the amount of alcohol consumed is high, whether one flushes after drinking (flusher), and whether one smokes. If these conditions occur frequently, the risk of esophageal cancer becomes higher and needs to be noticed and observed in the esophagus, and if necessary, iodine spraying is needed. Finally, Prof. Beyse analyzed the reasons for the appearance of flushes after alcohol consumption in people at high risk ……