Awake rigid endoscopy-guided laryngeal biopsy in high-risk tracheostomized patients: Our experience

Background: Patients presenting with laryngeal lesions and significant comorbidities are frequently unsuitable candidates for biopsy under general anaesthesia (GA). Awake, office-based procedures offer a safer alternative. This study evaluates the feasibility and safety of rigid 70-degree endoscopy-guided laryngeal biopsy in high-risk tracheostomized individuals. Methods: A prospective observational study was conducted on 26 tracheostomized patients with suspected laryngeal or hypopharyngeal lesions deemed unfit for GA. Biopsies were performed under local anaesthesia using a 70° rigid endoscope. Discomfort was assessed via a Visual Analogue Scale (VAS). Haemodynamic responses were closely monitored, and the adequacy of histopathological samples was assessed. Results: The procedure yielded diagnostic tissue in 88.46% of cases. Most patients (65.4%) reported mild discomfort (VAS 5–44); only 11.5% experienced severe discomfort. Statistically significant but clinically stable changes in pulse and blood pressure were observed post-procedure (p < 0.05). No major complications occurred. Histopathology revealed squamous cell carcinoma in 16 patients, premalignant lesions in 5, and benign keratosis in 2 cases. Conclusion: Awake rigid endoscopy-guided biopsy is a safe, effective, and well-tolerated alternative for tissue diagnosis in tracheostomized patients unfit for GA. It ensures timely histopathological confirmation with minimal risk and discomfort.