Timing for surgical intervention in DISHphagia

Abstract

Introduction:Dysphagia in old patients secondary to diffuse idiopathic skeletal hyperostosis (DISH) syndrome is underdiagnosed. Surgical resection of the offending osteophytes is the definitive treatment. However, the timing of surgery in the course of the disease is still controversial. The study tries to find a correlation if any, between the timing of osteophytectomy surgery aimed to relieve DISH syndrome-induced dysphagia and the surgical outcome.Methods:During the period from 2010 to 2015, clinical and radiological data of patients who presented with dysphagia attributed to DISH syndrome were retrospectively reviewed along with their management and outcome.Results:One female and seven male patients were included in the study. Mean age was 71 years. Mean duration of dysphagia was 3 years and 10 months. Surgical resection was attempted through anterolateral cervical approach in five cases who were fit for surgery, in which four showed complete resolution of dysphagia (one experienced transient hoarseness of voice for 4 weeks postoperatively), and the fifth showed minimal improvement after limited resection due to intraoperative finding of marked esophageal adherence to osteophytes. The two unfavorable outcomes (subtotal resection and transient hoarseness of voice) occurred in relatively older patients (average: 75.5 years) with longer standing dysphagia (average: 7 years).Conclusion:DISH syndrome as a cause of dysphagia is commonly underlooked. Surgical resection of the offending osteophytes through an anterolateral approach is a safe and effective procedure. For patients who are fit for surgery, older age or longer duration of dysphagia might be associated with less favorable surgical outcome.

Combined Anterior Osteophytectomy and Cricopharyngeal Myotomy for Treatment of DISH-Associated Dysphagia

“…11,12 However, symptom recurrence ranges in literature from 0% to 29% of series with 0% to 14% of patients requiring reoperation for resection of osteophytes. 11,19,20 In longer term follow-up when excluding patients in this study with 3 months or less follow-up, 100% (5/5) of patients noted improvement or resolution of symptoms but 40% (2/5) noted recurrence of symptoms clinically significant enough to require esophageal dilation. This is difficult to compare to other studies because most do not quantify need for further less invasive intervention such as esophageal dilation.…”

“…11 However, symptomatic recurrence in OP patients ranges from 0% to 29% of series with 0% to 14% of patients requiring reoperation for resection of osteophytes. 11,12,19,20 In more extensive series, 18% of patients noted symptom recurrence but none required reoperation. 10 It is important to note that other studies do not detail the need for further esophageal dilation postoperatively and may have been performed without inclusion in the results or discussion.…”

Surgical Treatment of Dysphagia Secondary to Anterior Cervical Osteophytes Due to Diffuse Idiopathic Skeletal Hyperostosis

“…In a study by Mattioli et al, more than half of the patients (12/21) underwent elective tracheotomy for wide prevascular retrovisceral exposure, and three of them experienced additional procedures due to postoperative complications (two postoperative hemorrhage and one postoperative dyspnea) [ 1 ]. As we could locate the bottleneck point between the vertebral body and the bony excrescence in all previous studies where CT images were available [ 1 , 10 , 17 , 18 , 20 , 22 , 23 , 24 , 25 , 26 ], we believe that this method can generally be applied to other cases.…”

Surgical management of Diffuse Idiopathic Skeletal Hyperostosis (DISH) causing secondary dysphagia (Narrative review)

“…Computerized tomography (CT) scan and magnetic resonance imaging (MRI) can assess the esophagus, along with a barium swallow test. 19 However, patients with dysphagia from other causes, such as neurological dysphagia from stroke, Parkinson's disease, multiple sclerosis, or dementia, need to be excluded. [5][6][7] In addition, malignancies such as laryngeal or esophageal cancer may be the cause of dysphagia.…”