Subscribe to RSS
DOI: 10.1055/s-0043-110670
Clinical utility of a functional lumen imaging probe in management of dysphagia following head and neck cancer therapies
Publication History
submitted 21 November 2016
accepted after revision 13 April 2017
Publication Date:
31 May 2017 (online)
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.
-
References
- 1 Szczesniak MM, Maclean J, Zhang T. et al. Persistent dysphagia after head and neck radiotherapy: a common and under-reported complication with significant effect on non-cancer-related mortality. Clin Oncol 2014; 26: 697-703
- 2 Piotet E, Escher A, Monnier P. Esophageal and pharyngeal strictures: report on 1,862 endoscopic dilatations using the Savary-Gilliard technique. Eur Arch Otorhinolaryngol 2008; 265: 357-364
- 3 Ekberg O, Pokieser P. Radiologic evaluation of dysphagic patient. European Radiol 1997; 7: 1285-1295
- 4 Kim Y, McCullough GH. Maximal hyoid excursion in poststroke patients. Dysphagia 2010; 25: 20-25
- 5 Szczesniak MM, Maclean J, OʼHare J. et al. Videofluoroscopic swallow examination does not accurately detect cricopharyngeal radiation strictures. Otolaryngol Head Neck Surg 2016; 155: 462-465
- 6 Kwiatek MA, Pandolfino JE, Hirano I. et al. Esophagogastric junction distensibility assessed with an endoscopic functional luminal imaging probe (EndoFLIP). Gastrointest Endosc 2010; 72: 272-278
- 7 Verlaan T, Rohof WO, Bredenoord AJ. et al. Effect of peroral endoscopic myotomy on esophagogastric junction physiology in patients with achalasia. Gastrointest Endosc 2013; 78: 39-44
- 8 Rohof WO, Hirsch DP, Kessing BF. et al. Efficacy of treatment for patients with achalasia depends on the distensibility of the esophagogastric junction. Gastroenterology 2012; 143: 328-335
- 9 Rieder E, Swanstrom LL, Perretta S. et al. Intraoperative assessment of esophagogastric junction distensibility during per oral endoscopic myotomy (POEM) for esophageal motility disorders. Surg Endosc 2013; 27: 400-405
- 10 Kwiatek MA, Hirano I, Kahrilas PJ. et al. Mechanical properties of the esophagus in eosinophilic esophagitis. Gastroenterology 2011; 140: 82-90
- 11 Gyawali CP, Bredenoord AJ, Conklin JL. et al. Evaluation of esophageal motor function in clinical practice. Neurogastroenterol Motil 2013; 25: 99-133
- 12 Kunwald P, Drewes AM, Kjaer D. et al. A new distensibility technique to measure sphincter of Oddi function. Neurogastroenterol Motil 2010; 22: 978-983 e253
- 13 Ilczyszyn A, Botha AJ. Feasibility of esophagogastric junction distensibility measurement during Nissen fundoplication. Dis Esophagus 2014; 27: 637-644
- 14 Regan J, Walshe M, Timon C. et al. Endoflip(R) evaluation of pharyngo-oesophageal segment tone and swallowing in a clinical population: a total laryngectomy case series. Clin Otolaryngol 2015; 40: 121-129
- 15 Cook IJ. Diagnostic evaluation of dysphagia. Nature clinical practice Gastroenterol Hepatol 2008; 5: 393-403
- 16 Wallace KL, Middleton S, Cook IJ. Development and validation of a self-report symptom inventory to assess the severity of oral-pharyngeal dysphagia. Gastroenterology 2000; 118: 678-687
- 17 Dwivedi RC, St Rose S, Roe JW. et al. Validation of the Sydney Swallow Questionnaire (SSQ) in a cohort of head and neck cancer patients. Oral Oncol 2010; 46: e10-e14
- 18 Szczesniak MM, Maclean J, Zhang T. et al. The normative range for and age and gender effects on the Sydney Swallow Questionnaire (SSQ). Dysphagia 2014; 29: 535-538
- 19 Matthews JN, Altman DG, Campbell MJ. et al. Analysis of serial measurements in medical research. BMJ 1990; 300: 230-235
- 20 Bland JM, Altman DG. Statistical methods for assessing agreement between two methods of clinical measurement. Lancet 1986; 1: 307-310
- 21 Metz A, Cook IJ. Diagnostic utility, efficacy and safety of empiric esophageal dilatation in unexplained dysphagia. J Gastroenterol Hepatol 2008; 23: A237
- 22 Zu Y, Yang Z, Perlman AL. Hyoid displacement in post-treatment cancer patients: preliminary findings. J Speech Lang Hear Res 2011; 54: 813-820
- 23 Cook IJ, Dent J, Shannon S. et al. Measurement of upper esophageal sphincter pressure: effect of acute emotional stress. Gastroenterology 1987; 93: 526-532
- 24 Kahrilas P, Dodds W, Dent J. et al. Effect of sleep, spontaneous gastroesophageal reflux, and a meal on upper esophageal sphincter pressure in normal human volunteers. Gastroenterology 1987; 92: 466-471
- 25 Szczesniak MM, Fuentealba SE, Burnett A. et al. Differential relaxation and contractile responses of the human upper esophageal sphincter mediated by interplay of mucosal and deep mechanoreceptor activation. Am J Gastroenterol 2008; 294: G982-G988
- 26 Regan J, Walshe M, Rommel N. et al. New measures of upper esophageal sphincter distensibility and opening patterns during swallowing in healthy subjects using EndoFLIP(R). Neurogastroenterol Motil 2013; 25: e25-e34