West Jacob, Kim Cherine H, Reichert Zachary, Krishna Priya, Crawley Brianna K, Inman Jared C
Loma Linda University School of Medicine, Loma Linda, California, U.S.A.
Department of Otolaryngology-Head and Neck Surgery, Loma Linda University Health, Loma Linda, California, U.S.A.
Laryngoscope. 2018 Sep;128(9):2022-2028. doi: 10.1002/lary.27072. Epub 2018 Jan 4.
Cervical esophageal stenosis is often diagnosed with a qualitative evaluation of a barium esophagram. Although the esophagram is frequently the initial screening exam for dysphagia, a clear objective standard for stenosis has not been defined. In this study, we measured esophagram diameters in order to establish a quantitative standard for defining cervical esophageal stenosis that requires surgical intervention.
Single institution case-control study.
Patients with clinically significant cervical esophageal stenosis defined by moderate symptoms of dysphagia (Functional Outcome Swallowing Scale > 2 and Functional Oral Intake Scale < 6) persisting for 6 months and responding to dilation treatment were matched with age, sex, and height controls. Both qualitative and quantitative barium esophagram measurements for the upper, mid-, and lower vertebral bodies of C5 through T1 were analyzed in lateral, oblique, and anterior-posterior views.
Stenotic patients versus nonstenotic controls showed no significant differences in age, sex, height, body mass index, or ethnicity. Stenosis was most commonly at the sixth cervical vertebra (C 6) lower border and C7 upper border. The mean intraesophageal minimum/maximum ratios of controls and stenotic groups in the lateral view were 0.63 ± 0.08 and 0.36 ± 0.12, respectively (P < 0.0001). Receiver operating characteristic analysis of the minimum/maximum ratios, with a <0.50 ratio delineating stenosis, demonstrated that lateral view measurements had the best diagnostic ability. The sensitivity of the radiologists' qualitative interpretation was 56%. With application of lateral intraesophageal minimum/maximum ratios, we observed improved sensitivity to 94% of the esophagram, detecting clinically significant stenosis.
Applying quantitative determinants in esophagram analysis may improve the sensitivity of detecting cervical esophageal stenosis in dysphagic patients who may benefit from surgical therapy.
IIIb. Laryngoscope, 128:2022-2028, 2018.
颈段食管狭窄通常通过食管钡餐造影的定性评估来诊断。尽管食管造影常常是吞咽困难的初始筛查检查，但尚未确定明确的狭窄客观标准。在本研究中，我们测量食管造影的直径，以建立一个用于定义需要手术干预的颈段食管狭窄的定量标准。
单机构病例对照研究。
将因中度吞咽困难症状（功能性吞咽结果量表＞2且功能性经口进食量表＜6）持续6个月且对扩张治疗有反应而被定义为具有临床显著颈段食管狭窄的患者与年龄、性别和身高相匹配的对照者进行配对。对C5至T1椎体上、中、下部分的食管钡餐造影进行定性和定量测量，并在侧位、斜位和前后位视图下进行分析。
狭窄患者与无狭窄对照者在年龄、性别、身高、体重指数或种族方面无显著差异。狭窄最常见于第六颈椎（C6）下缘和C7上缘。在侧位视图中，对照组和狭窄组的平均食管内最小/最大比值分别为0.63±0.08和0.36±0.12（P＜0.0001）。最小/最大比值的受试者工作特征分析显示，比值＜0.50界定为狭窄，结果表明侧位视图测量具有最佳诊断能力。放射科医生定性解读的敏感性为56%。应用食管内最小/最大比值的侧位测量，我们观察到食管造影的敏感性提高到94%，能够检测出具有临床意义的狭窄。
在食管造影分析中应用定量指标可能会提高对吞咽困难患者颈段食管狭窄的检测敏感性，这些患者可能从手术治疗中获益。
IIIb。《喉镜》，128:2022 - 2028，2018年。
