Determining the efficacy of the chin-down maneuver following esophagectomy with fiberoptic endoscopic evaluation of swallowing

Publication date: Available online 2 November 2018

Source: Archives of Physical Medicine and Rehabilitation

Author(s): Yoshihiko Kumai, Takumi Miyamoto, Keigo Matsubara, Yasuhiro Samejima, Naoya Yoshida

Objectives

To clarify the reliability of fiberoptic endoscopic evaluation of swallowing (FEES) compared to videofluoroscopic swallowing studies (VFSSs). Second, we explored the effect of the chin-down maneuver in the presence or absence of vocal fold paralysis (VFP) using FEES in patients with three-field lymphadenectomy (3FL) post-esophagectomy.

Design

Retrospective data collection from FEES and VFSS

Setting

Dysphagic clinics at ENT department.

Participants

Fifteen patients underwent esophagectomy with 3FL at the Department of Gastroenterological Surgery, during a period of 12 months.

Interventions

The patients underwent FEES and VFSS with neutral and chin-down maneuvers 2 weeks postoperatively. Two raters of speech pathology blindly scored aspiration, penetration, delayed initiation, and pharyngeal clearance in the pyriform sinus (PCPS) and vallecula, respectively, from recorded movie clips of both examinations, using the penetration aspiration scale (PAS) and modified Hyodo's FEES rating scale.

Main Outcome Measures

The intra- and inter-rater correlation coefficients of each parameter examined with FEES. Statistical comparison of each parameter between FEES and VFSS and of each parameter evaluated using FEES between two maneuvers with or without VFP.

Results

The intra- and inter-rater correlation coefficients of the PAS and PCPS examined with FEES were both statistically consistent between the two raters. The PAS and PCPS evaluated using FEES were significantly correlated with those evaluated in a VFSS (p<0.05). The two parameters evaluated using FEES were significantly (p<0.05) improved with the chin-down maneuver compared to the neutral maneuver, especially in VFP patients.

Conclusion

FEES performed post-esophagectomy with 3FL for evaluation of aspiration is as reliable statistically as VFSSs. The chin-down maneuver is especially useful for reducing the PAS score, and PCPS in VFP patients.

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