Author(s)
Phong T. Le, MD
Lucinda A. Halstead, MD
Affiliation(s)
Medical University of South Carolina
Abstract:
Educational Objective: At the conclusion of this presentation, the participants should be able to compare effectiveness of an FDA approved upper esophageal assist device in treating challenging cases of aspiration due to radiation and surgically induced patulous upper esophageal sphincters (UES). Objectives: Demonstrate effectiveness of an FDA approved upper esophageal assist device in treating challenging cases of aspiration due to radiation and surgically induced patulous upper esophageal sphincters (UES). Study Design: Case series. Methods: Symptom presentation, Reflux Symptom Index (RSI), endolaryngeal examinations and treatment outcomes from 3 patients, aged 48-72, were reviewed before and after an UES assist device. Results: Two patients with patulous UES resulting from dilation of radiation induced UES stenosis, and one patient with completely patulous UES from congenital tracheoesophageal fistula repaired by colonic interposition 47 years ago, reported symptomatic improvement and maintained compliance with the device for greater than 6 months. RSI scores improved. Endolaryngeal examination in irradiated patients demonstrated reshaping of the patulous UES to a more physiologic kidney bean shape and a tendency for the UES to close for brief periods of time without the device. The colonic interposition patient experienced less aspiration pneumonias from 6-8/year to one episode in 6 months. Conclusions: As many head and neck cancer patients suffer radiation induced UES stenosis or have esophageal anastomoses high in the neck, less severe forms of this complication are likely occurring frequently and are left untreated. This study demonstrates considerable resolution of aspiration and reshaping of the patulous UES to a more physiologic shape in irradiated patients. It decreased aspiration and eructation with speaking in all patients without changing their ability to swallow. This study highlights a unique and easily applied treatment to a difficult problem.