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Endoscopy 2017; 49(09): 848-854
DOI: 10.1055/s-0043-110670
Original article
© Georg Thieme Verlag KG Stuttgart · New York

Clinical utility of a functional lumen imaging probe in management of dysphagia following head and neck cancer therapies

Peter I. Wu
1   Department of Gastroenterology and Hepatology, St George Hospital, Sydney, New South Wales, Australia
2   St George Clinical School, University of New South Wales, Sydney, New South Wales, Australia
,
Michal M. Szczesniak
1   Department of Gastroenterology and Hepatology, St George Hospital, Sydney, New South Wales, Australia
2   St George Clinical School, University of New South Wales, Sydney, New South Wales, Australia
,
Julia Maclean
3   Speech Pathology Department, St George Hospital, Sydney, New South Wales, Australia
,
Lennart Choo
1   Department of Gastroenterology and Hepatology, St George Hospital, Sydney, New South Wales, Australia
,
Harry Quon
5   Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins Hospital, Baltimore, Maryland, USA
6   Department of Otolaryngology – Head and Neck Surgery, Johns Hopkins University, Baltimore, Maryland, USA
,
Peter H. Graham
4   Department of Radiation Oncology, Cancer Care Centre, St George Hospital, Sydney, New South Wales, Australia
,
Teng Zhang
1   Department of Gastroenterology and Hepatology, St George Hospital, Sydney, New South Wales, Australia
2   St George Clinical School, University of New South Wales, Sydney, New South Wales, Australia
,
Ian J. Cook
1   Department of Gastroenterology and Hepatology, St George Hospital, Sydney, New South Wales, Australia
2   St George Clinical School, University of New South Wales, Sydney, New South Wales, Australia
› Author Affiliations
Further Information

Publication History

submitted 21 November 2016

accepted after revision 13 April 2017

Publication Date:
31 May 2017 (online)

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Abstract

Background and aims Chemoradiotherapy for head and neck cancer (HNC) with/without laryngectomy commonly causes dysphagia. Pharyngoesophageal junction (PEJ) stricturing is an important contributor. We aimed to validate a functional lumen imaging probe (the EndoFLIP system) as a tool for quantitating pretreatment PEJ distensibility and treatment-related changes in HNC survivors with dysphagia and to evaluate the diagnostic accuracy of EndoFLIP-derived distensibility in detecting PEJ strictures.

Methods We studied 34 consecutive HNC survivors with long-term (> 12 months) dysphagia who underwent endoscopic dilation for suspected strictures. Twenty non-dysphagic patients undergoing routine endoscopy served as controls. PEJ distensibility was measured at endoscopy with the EndoFLIP system pre- and post-dilation. PEJ stricture was defined as the presence of a mucosal tear post-dilation.

Results PEJ stricture was confirmed in 22/34 HNC patients (65 %). During distension up to 60 mmHg, the mean EndoFLIP-derived narrowest cross-sectional area (nCSA) in HNC patients with strictures, without strictures, and in controls were 58 mm2 (95 % confidence interval [CI] 22 to 118), 195 mm2 (95 %CI 129 to 334), and 227 mm2 (95 %CI 168 to 316), respectively. A cutoff of 114 mm2 for the nCSA at the PEJ had perfect diagnostic accuracy in detecting strictures (area under the receiver operating characteristic curve = 1). In patients with strictures, a single session of dilation increased the nCSA by 29 mm2 (95 %CI 20 to 37; P < 0.001). In patients with no strictures, dilation caused no change in the nCSA (mean difference 13 mm2 [95 %CI −4 to 30]; P = 0.13).

Conclusions EndoFLIP is a highly accurate technique for the detection of PEJ strictures. EndoFLIP may complement conventional diagnostic tools in the detection of pharyngeal outflow obstruction.