Logan Ashley M, Gawlik Alexandria E, Aden James K, Jarvis Natalie C, Dion Gregory R
Department of Otolaryngology-Head and Neck Surgery, Brooke Army Medical Center, Joint Base San Antonio-Fort Sam Houston, TX.
Department of Surgery, Brooke Army Medical Center, Joint Base San Antonio-Fort Sam Houston, TX.
J Speech Lang Hear Res. 2020 Nov 13;63(11):3594-3599. doi: 10.1044/2020_JSLHR-19-00401. Epub 2020 Sep 30.
Purpose Patients receive multiple bolus trials during a videofluoroscopic swallowing study (VFSS) to assess swallow function, inclusive of narrowing within the pharyngoesophageal segment (PES). While differences in the narrowest and widest segments are visualized, the ratio of distention across boluses is not well understood. Method A retrospective review of 50 consecutive VFSSs with five boluses of varied viscosity and volume was performed. Still images at maximal PES distention were captured and scaled using a 19-mm disk. Measurements of the narrowest and widest segments were obtained, and a distention ratio was calculated. Studies were categorized by PES phenotype as normal, esophageal web, cricopharyngeal bar, or narrow PES. PES distention ratios were evaluated across bolus trials and within PES phenotypes using a mixed-methods repeated-measures analysis of variance. Results Of the 50 studies, there were 11 normal, 16 web, 10 bar, and 13 narrow PES. Quantitative differences were present for the narrowest ( = .01) and widest ( = .002) points across bolus volumes. No difference was present in distention ratio ( = .2) across volumes. Evaluating the PES phenotype, web, normal, bar, and narrow PES distention ratios differed ( = .03). Bar and PES narrow distention ratios were lower compared to that of the normal group ( = .01 for normal vs. bar and = .02 for normal vs. PES narrow). Conclusions PES distention ratio stability across varying bolus volumes and phenotypes suggests that a reduction in trials during a VFSS may permit an equivalent PES evaluation to traditional exams. Ultimately, this could improve our understanding and accurate diagnosis of PES dysfunction.
目的 在视频荧光吞咽造影检查（VFSS）期间，患者会接受多次团注试验以评估吞咽功能，包括咽食管段（PES）的狭窄情况。虽然可以观察到最窄段和最宽段的差异，但不同团注之间的扩张比例尚未得到充分了解。方法 对连续50例VFSS进行回顾性分析，这些VFSS包含五次不同粘度和体积的团注。在PES最大扩张时采集静态图像，并使用19毫米圆盘进行缩放。获取最窄段和最宽段的测量值，并计算扩张比例。根据PES表型将研究分为正常、食管蹼、环咽肌条或狭窄PES。使用混合方法重复测量方差分析评估不同团注试验以及不同PES表型内的PES扩张比例。结果 在50项研究中，有11例正常、16例食管蹼、10例环咽肌条和13例狭窄PES。不同团注体积的最窄点（P = 0.01）和最宽点（P = 0.002）存在定量差异。不同体积的扩张比例无差异（P = 0.2）。评估PES表型时，食管蹼、正常、环咽肌条和狭窄PES的扩张比例存在差异（P = 0.03）。与正常组相比，环咽肌条和狭窄PES的扩张比例较低（正常与环咽肌条相比P = 0.01，正常与狭窄PES相比P = 0.02）。结论 在不同团注体积和表型下，PES扩张比例具有稳定性，这表明在VFSS期间减少试验次数可能允许对PES进行与传统检查等效的评估。最终，这可以提高我们对PES功能障碍的理解和准确诊断。
