Empiric Dilation in Non-obstructive Dysphagia

Olson, Jeffrey S.; Lieberman, David A.; Sonnenberg, Amnon

doi:10.1007/s10620-007-0024-x

Cited by 13 publications

(6 citation statements)

References 15 publications

(19 reference statements)

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“…Due to the use of de‐identified data only, the study was granted a waiver of consent by the institutional review board at the Oregon Health & Science University. Multiple previous studies have utilised CORI data for peer‐reviewed publications 11–19 …”

Section: Methodsmentioning

confidence: 99%

Epidemiology and practice patterns of achalasia in a large multi-centre database

Enestvedt

Williams

Sonnenberg

2011

Alimentary Pharmacology &Amp; Therapeutics

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Background and Aims Because of its rarity, achalasia remains a difficult disease to study. The aim of the present analysis was to describe the epidemiology of achalasia and practice patterns in its endoscopic management, utilizing patient records from a large national database of endoscopic procedures. Methods The Clinical Outcomes Research Initiative (CORI) maintains a database of endoscopic procedures in diverse clinical practices. The data from 89 endoscopy practices distributed throughout the US during 2000–2008 were used to analyze the characteristics and therapy of patients with achalasia. Results Among 521,497 upper endoscopies during the study period, we identified 896 patients with achalasia. Compared with the entirety of all other endoscopic diagnoses, achalasia was more common in men than women (OR=1.39, CI 1.22–1.59), but similar among non-whites and whites (OR=0.87, CI 0.74–1.03). Relatively more achalasia patients were treated at university than community practices (OR=1.52, CI 1.30–1.78). Botox injection was most frequently used as first choice of endoscopic therapy in 41%, followed by balloon dilation in 21%, Savary dilation in 20%, Maloney dilation in 10%, Rigiflex in 4%, and other modalities in 4% of patients. One quarter of achalasia patients treated endoscopically underwent a repeat therapy about every 14 months. Conclusions Botox has become the primary choice of initial endoscopic therapy in achalasia. Despite their partial deviation from guidelines and recommendations, these endoscopic patterns reflect the current clinical practice in the United States.

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Section: Methodsmentioning

confidence: 99%

Epidemiology and practice patterns of achalasia in a large multi-centre database

Enestvedt

Williams

Sonnenberg

2011

Alimentary Pharmacology &Amp; Therapeutics

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“…Difficulties in diagnosing cervical esophageal stenosis may be partly due to falsely reassuring imaging studies. In the gastroenterology literature, empiric esophageal dilation is commonly performed despite negative imaging and endoscopy 12 . However, this has not been widely considered or performed in the otolaryngology population.…”

Section: Discussionmentioning

confidence: 99%

“…In the gastroenterology literature, empiric esophageal dilation is commonly performed despite negative imaging and endoscopy. 12 However, this has not been widely considered or performed in the otolaryngology population. More often, when an esophagram is negative for stenosis, it is likely believed that performing a dilation will not be effective since there is no structural obstruction.…”

Section: Discussionmentioning

confidence: 99%

Esophageal stenosis in head and neck cancer patients: Imaging's accuracy to predict dilation response

Krishna

Bomze

Watson

et al. 2021

Laryngoscope Investig Oto

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Objectives The primary goal of this study was to examine how well findings of cervical esophageal stenosis on modified barium swallow (MBS) and esophagram correlate with clinical improvement following dilation in patients with a history of head and neck (H&N) cancer. Methods A retrospective review was performed at an academic hospital. The study population included H&N cancer patients with a history of neck dissection surgery who underwent esophageal dilation from 2010 to2018. Pre and postdilation swallowing function was assessed. The Functional Outcomes Swallowing Scale (FOSS) and Functional Oral Intake Scale (FOIS) were used as outcome measures. Results The 95 patients were included. All patients had imaging prior to dilation. Post‐dilation FOSS and FOIS scores were significantly improved (P < .001). In identifying the patients that would have improvement from dilation, esophagram and MBS had average sensitivities of 81% and 82%, respectively. The negative predictive value (ie, the ability of a normal esophagram or normal MBS to exclude patients that would not improve with dilation) was only 46% and 38%, respectively. When the specific finding of aspiration on MBS was considered, the positive predictive value (PPV) (ie, the ability of an MBS positive for aspiration to predict that a patient would benefit from dilation) was 87% (P = .03). When only the specific finding of stenosis on esophagram was considered, the PPV of improvement post‐dilation was 58% (P = .97). The delay in time from imaging to dilation was significantly longer in those who had an unidentified stenosis (false negative) on imaging when compared to those who did not (46.8 ± 35.2 days vs 312.6 ± 244.1 days, P < .001). Conclusion In high risk patients for cervical esophageal stenosis, such as those with a history of H&N cancer and open neck surgery with or without radiation, MBS and esophagram appear to have mixed reliability as predictors of response to esophageal dilation. In these patients, a “negative” result on MBS and esophagram may not be diagnostically accurate enough to exclude patients from consideration of dilation. Level of Evidence IIb

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“…The literature describes empiric dilation of the esophagus without apparent evidence of esophageal web or stricture . The GI literature describes this entity as nonobstructive dysphagia.…”

Section: Discussionmentioning

confidence: 99%

“…The literature describes empiric dilation of the esophagus without apparent evidence of esophageal web or stricture. [13][14][15][16][17][18][19][20][21] The GI literature describes this entity as nonobstructive dysphagia. Marshall and Chowdhury 13 demonstrated near-complete resolution of nonobstructive solid food dysphagia in 19 of 20 patients with empiric bougie dilation.…”

Section: Discussionmentioning

confidence: 99%

The Prevalence of Cricopharyngeal Webs in Elderly Cadavers

et al. 2018

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Objective Cricopharyngeal webs (CPW) are a frequent cause of solid food dysphagia. They are difficult to diagnose and are often missed on swallowing fluoroscopy. The prevalence of CPWs is uncertain. The purpose of this study was to determine the prevalence of CPWs in elderly cadavers. Methods Direct laryngoscopy and cervical esophagoscopy were performed in 19 embalmed cadavers by independent two‐clinician consensus. Cadaver demographics and the presence and laterality of a CPW were recorded. The prevalence of CPW was calculated, and the size of the cricopharyngeus muscle (CPM) was quantified. Results The mean age of the cohort was 83 ( ± 12) years. Fifty‐three percent were female, and the mean body mass index was 19.7 ( ± 3). The causes of death were cardiovascular disease (10 of 19), cancer (5 of 19), and respiratory failure (4 of 19). A CPW was present in 68% (13 of 19) of cadavers. Forty‐seven percent (9 of 19) had a unilateral web, and 21% (4 of 19) had a bilateral web. There was no laterality predominance (P > 0.05). Forty‐two percent (8 of 19) had no CPM prominence; 32% (6 of 19) had a small/moderate CPM prominence; and 26% (5 of 19) had a significant CPM prominence. Conclusion The prevalence of cricopharyngeal webs in elderly cadavers is high (68%). The clinician should maintain a high index of suspicion for CPWs in patients with no other identifiable etiology of solid food dysphagia. Level of Evidence 3b Laryngoscope, 129:63–66, 2019

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Empiric Dilation in Non-obstructive Dysphagia

Cited by 13 publications

References 15 publications

Epidemiology and practice patterns of achalasia in a large multi-centre database

Epidemiology and practice patterns of achalasia in a large multi-centre database

Esophageal stenosis in head and neck cancer patients: Imaging's accuracy to predict dilation response

The Prevalence of Cricopharyngeal Webs in Elderly Cadavers

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