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CC BY-NC-ND 4.0 · Endosc Int Open 2021; 09(04): E646-E652
DOI: 10.1055/a-1380-3224
Original article

Functional endoscopy in neurogenic dysphagia: a feasibility study focusing on the esophageal phase of swallowing

Jan Rückert
1   Department of Medicine I, Josephs-Hospital Warendorf, Academic Teaching Hospital, University of Muenster, Warendorf, Germany
,
Philipp Lenz
2   Department of Medicine B, University of Muenster, Muenster, Germany
3   Department of Palliative Medicine, University of Muenster, Muenster, Germany
,
Hauke Heinzow
2   Department of Medicine B, University of Muenster, Muenster, Germany
,
Johannes Wessling
4   Department of Clinical Radiology, University of Muenster, Muenster, Germany
5   Department of Radiology, Clemens Hospital Muenster, Muenster, Germany
,
Tobias Warnecke
6   Department of Neurology, University of Muenster, Muenster, Germany
,
Ingo F. Herrmann
7   Reflux Center Duesseldorf, ENT, Duesseldorf, Germany
,
Michael Strahl
7   Reflux Center Duesseldorf, ENT, Duesseldorf, Germany
,
Frank Lenze
1   Department of Medicine I, Josephs-Hospital Warendorf, Academic Teaching Hospital, University of Muenster, Warendorf, Germany
,
Tobias Nowacki
1   Department of Medicine I, Josephs-Hospital Warendorf, Academic Teaching Hospital, University of Muenster, Warendorf, Germany
2   Department of Medicine B, University of Muenster, Muenster, Germany
,
Dirk Domagk
1   Department of Medicine I, Josephs-Hospital Warendorf, Academic Teaching Hospital, University of Muenster, Warendorf, Germany
2   Department of Medicine B, University of Muenster, Muenster, Germany
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Abstract

Background and study aims Due to demographic transition, neurogenic dysphagia has become an increasingly recognized problem. Patients suffering from dysphagia often get caught between different clinical disciplines. In this study, we implemented a defined examination protocol for evaluating the whole swallowing process by functional endoscopy. Special focus was put on the esophageal phase of swallowing.

Patients and methods This prospective observational multidisciplinary study evaluated 31 consecutive patients with suspected neurogenic dysphagia by transnasal access applying an ultrathin video endoscope. Thirty-one patients with gastroesophageal reflux symptoms were used as a control group. We applied a modified approach including standardized endoscopic positions to compare our findings with fiberoptic endoscopic evaluation of swallowing and high-resolution manometry. The primary outcome measure was feasibility of functional endoscopy. Secondary outcome measures were adverse events (AEs), tolerability, and pathologic endoscopic findings.

Results Functional endoscopy was successfully performed in all patients. No AEs were recorded. A variety of disorders were documented by functional endoscopy: incomplete or delayed closure of the upper esophageal sphincter in retroflex view, clearance disturbance of tubular esophagus, esophageal hyperperistalsis, and hypomotility. Analysis of results obtained with the diagnostic tools showed some discrepancies.

Conclusions By interdisciplinary cooperation with additional assessment of the esophageal phase of deglutition using the innovative method of functional endoscopy, the diagnosis of neurogenic disorders including dysphagia may be significantly improved, leading to a better clinical understanding of complex dysfunctional patterns. To the best of our knowledge, this is the first study to show that a retroflex view of the ultrathin video endoscope within the esophagus can be safely performed. [NCT01995929]

Supplementary material



Publication History

Received: 17 August 2020

Accepted: 30 December 2020

Article published online:
15 April 2021

© 2021. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

Georg Thieme Verlag KG
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