Diagnostic Value of White-Light Endoscopy, Narrow-Band Imaging, and Chromoendoscopy in Detecting Esophageal Involvement in Oral Lichen Planus and Based Squamous Cell Carcinoma

Introduction: Oral lichen planus (OLP) is a chronic inflammatory condition and a precancerous lesion of OLP based oral squamous cell carcinoma (OSCC), with possible esophageal involvement (esophageal lichen planus, ELP), though the latter prevalence and clinical significance remain uncertain. This study aimed to determine ELP prevalence in OLP/OSCC patients, assess the diagnostic performance of white-light endoscopy (WLE), narrow-band imaging (NBI), and Lugol’s iodine staining based chromoendoscopy, and evaluate histologic findings for potential prognostic implications. Methods: In this prospective single-center study (2011–2020), 81 adults with confirmed OLP and about 50 % history of OSCC underwent esophagogastroduodenoscopy (EGD) using WLE, NBI, and chromoendoscopy. Biopsies were taken from visually suspicious areas and from normal-appearing mucosa throughout the esophagus, stomach and duodenum. Results: ELP was identified in only four patients (4,9 %), all of whom were asymptomatic or had minimal symptoms. In three cases, ELP was detected only via random biopsies despite normal endoscopic appearance. The sensitivity of WLE, NBI, and chromoendoscopy was low, with Lugol´s staining yielding false positives due to benign changes like glycogen acanthosis. No dysplasia or carcinoma was observed. Conclusion: Even in one of the largest prospective studies, ELP remained a rare finding, often clinically silent, and frequently undetectable on endoscopy. Step biopsies are essential for diagnosis. EGD screening in OLP may be considered as a one-time index endoscopy, supplemented by symptom-based evaluation in selected cases. ELP does not appear to increase short-term malignancy risk, and management should focus on symptom control and avoiding complications.