Esophagography and esophagoscopy.

To the Editor .—We feel that we must respond to the article on "Esophagography and Esophagoscopy" by Nino-Murcia et al, 1 that appeared in the August 1990 issue of theArchives, with an entirely different point of view. We conducted a single-institution retrospective study to determine the incidence and time of appearance of additional primary esophageal malignancy in a large series (790 patients) of patients with index primary head and neck cancers. In addition, a smaller prospective study (268 patients) was carried out to determine the optimum diagnostic approach to this problem. In our prospective study, 268 patients underwent esophagography followed by esophagoscopy as part of their initial diagnostic evaluation. Our incidence of simultaneous esophageal malignancies was more or less in agreement with the authors' and with the findings of others—0.8% in our retrospective study and 1.9% in our prospective study. However, four of five esophageal cancers found at endoscopy