Improvement Of Dysphagia Research Articles

Terapias para la comunicación en personas con esclerosis múltiple

People with Multiple Sclerosis (MS) can present a variety of communication disorders that affect their roles and social participation, affecting their quality of life and that of their environment. An early approach to these people and their communication difficulties could improve/compensate/facilitate communication, minimizing the effects on their daily life. Purpose: To contribute with recommendations for communication therapy in people with MS. Method: narrative literature review related to the topic. Results: There are few investigations focused on the intervention of communication in people with MS, those found are works in small populations, with evaluations at the beginning and at the end of therapy. The most promising studies are those that show specific effects on speech, through the LSVT LOUD, which not only improves communicative effectiveness, but has also shown improvements in dysphagia (eating disorder). significant to consider interventions with the environment and aimed at the quality of life of the affected individuals and families. Conclusions: The different presentations that MS has and its individual characteristics in each person, makes it difficult to have specific evidence on the most effective types of therapy. Despite this, it is possible to use therapies focused on different communication symptoms and adapt them under certain considerations to address communication in people with MS.

Comparison of outcome of rigid and self-expanding stents for palliation of malignant dysphagia

Between 1984 and 2019, 1005 rigid prostheses and 423 self-expanding stents were inserted for palliation of malignant esophageal stenosis. The aim of this study was the comparison of the treatment results using the two types of prosthesis. Retrospective analysis has been performed comparing the characteristics and treatment results of the two patients groups referring to the technical success of the procedures, procedure-related complications, change in the quality of life, and survival time. A comparison of average ages, duration time of dysphagia, quantity of weight loss, and the progress of the malignancy proves that palliation with self-expanding stents made it possible to treat more patients in worse condition. The number of complications in the patient group treated with stents was significantly higher at 29.3%/20.9%. Endoscopic intervention was performed to treat complications in 68.6% of cases with rigid prostheses and in 53.2% of patients treated with stents. Relevant improvement of dysphagia and the patients' quality of life was observed in 97% of those who were treated with a rigid prosthesis and in 91.3% of those who were treated with self-expanding stents. The survival time in the group of patients treated with stents was significantly shorter by 4.3/5.4 months than in the other group. The use of self-expanding stents in palliative treatment of malignant strictures have brought significant changes in everyday practice with increasing the possibilities. The treatment results were not improved by their application as much as the worse condition of the patient group worsened them. Orv Hetil. 2022; 163(49): 1952-1961.

Novel technique of flexible endoscopic therapy of Zenker’s diverticulum using a pulsed Holmium laser—a retrospective single-center analysis

BackgroundIn recent years, flexible endoscopic therapy of Zenker’s diverticulum seems to become the standard approach. The aim of this study was to assess the safety, efficacy and short-term outcome of flexible endoscopic diverticulotomy of Zenker’s diverticulum with a pulsed Holmium laser (PHL).Patients and methodsAll patients treated with endoscopic laser-diverticulotomy using a PHL between February 2013 and November 2021 at the University Hospital Salzburg were extracted from our prospectively maintained endoscopic database. Demographic data, size of Zenker’s diverticulum, procedure duration, complications, short-term outcome and rate of recurrence were evaluated.ResultsIn the study period, 45 procedures in 36 patients were performed. Mean depth of the Zenker diverticulum was 21 mm (10–60 mm), mean procedure time was 31 min (15–60 min), intraprocedural adverse events occurred in 2 out of 45 patients (5%) which were both managed endoscopically, post-procedural stenosis occurred in 1 patient (2%). In the follow-up examinations (mean follow-up after 6.4 months), 27 out of 36 patients (75%) were symptom-free, 6 patients (17%) reported an improvement of dysphagia. 3 patients (9%) suffered from persistent dysphagia. After initial symptom relief, a recurrent diverticulum occurred in 5 patients. Endoscopic re-intervention with PHL was done in these cases.ConclusionsFlexible endoscopic treatment of primary and recurrent Zenker’s diverticulum using a PHL is a promising, safe and effective treatment with, in our opinion, technical advantages in comparison to the CO2 laser. Further controlled prospective trials are needed.

Seronegative Myasthenia Gravis Presenting as Dysphagia in a Young Male- A Diagnostic Dilemma

21year old gentleman presented with insidious onset, gradually progressive dysphagia for 2 weeks. There was no other associated signs or symptoms. Initial blood workup, radiological investigations and diagnostic interventions were non-contributory. In the meantime, dysphagia worsened and was found to be progressive with advancement of the day. Oesophageal manometric studies showed gradual weakening of peristaltic contractions after a string of repetitive swallows. Repetitive nerve stimulation test and edrophonium test were suggestive of Myasthenia Gravis; Anti-acetylcholine receptor antibody and anti-MuSK antibody were negative. He was initiated on Pyridostigmine and had improvement of dysphagia after a few days. He has now achieved remission. Hence, we present a curious case of Seronegative Myasthenia Gravis in a young gentleman who presented with only dysphagia recovered with Pyridostigmine.

Effect of acupuncture on long-term outcomes in patients with post-stroke dysphagia

Acupuncture has been used to treat patients with post-stroke neurological dysfunction. The purpose of our observational study was to observe the long-term efficacy of acupuncture and investigate whether the acupuncture treatment could short the recovery time of patients with post-stroke dysphagia. Medical records were reviewed to select patients who met the inclusion criteria for post-stroke dysphagia. Exposure factor was defined as received acupuncture during inpatient. Clinical data were obtained at the 6-month follow-up. The primary outcome was the time to improve the score of Food Intake Level Scale (FILS, 0-10) by 3 grades. Cox regression models were used to assess the relationship between acupuncture and recovery of dysphagia. In acupuncture group, the median time to achieve clinical improvement of dysphagia was 97 days (95% CI, 93-124) compared with 119 days (95% CI, 108-145) in control group, with a statistically significant difference between the two groups (HR = 1.48; 95% CI 1.14-1.92; P = 0.003). At 6 months, 78 patients (60.5%) in acupuncture group reached excellent function and 61 patients (47.3%) in control group (RR = 1.28; 95% CI, 1.02-1.62; P = 0.045). 106 patients (82.2%) in acupuncture group achieved favorable function and 91 patients (70.5%) in control group (RR = 1.17; 95% CI, 1.02-1.35; P = 0.039). The outcome of adjusted multivariable Cox regression models showed that there was a difference in the recovery time of dysphagia between groups, HR = 1.79, 95% CI 1.34-2.39. The rates of adverse events were similar in both groups. Acupuncture can promote the recovery of post-stroke dysphagia, and has a better long-term efficacy. Besides, it can reduce the degree of disability and improve the quality of life.

Immunotherapy with or without radiotherapy for metastatic or recurrent esophageal squamous cell carcinoma: A real-world study

Background and purposeTo evaluate the efficiency and safety of immunotherapy combined with or without radiotherapy (RT) for metastatic or recurrent esophageal squamous cell carcinoma (ESCC). MethodsWe retrospectively reviewed data of 127 patients with metastatic or recurrent ESCC, who received immunotherapy with or without RT at Tianjin Medical University Cancer Institute between 2017 and 2021. ResultsThe median follow-up time was 15.7 months (95 % confidence interval (CI): 12.42–18.99). The median PFS of the RT and NRT groups was 5.45 months (95 % CI: 2.89–8.28) and 4.60 months (95 % CI: 3.75–7.06), respectively (P = 0.660). The median OS was 11.9 (95 % CI: 8.61–19.2) and 10.3 (95 % CI: 7.56–15.8) months, respectively (P = 0.890). The median PFS of locoregional recurrence patients in the RT and NRT groups was 11.27 months (95 % CI: 2.45–20.09) and 4.17 months (95 % CI: 2.64–5.71), respectively (P = 0.081). The median OS of locoregional recurrent patients in the RT and NRT groups was 19.48 months (95 % CI: 8.37–30.60) and 7.69 months (95 % CI: 3.45–11.93), respectively (P = 0.026). 64 % of patients in the RT group and 30 % of patients in the NRT group experienced an improvement in dysphagia (P = 0.033). No significant increase in treatment-related toxicity was observed in the RT group compared with the NRT group, except for some hematological complications. ConclusionsLocoregional recurrent patients gained survival benefits from immunotherapy combined with RT. The combination of immunotherapy and RT was safe in metastatic/recurrent ESCC patients. RT for the esophagus leads to the improvement of dysphagia compared to immunotherapy alone.

PSAT356 Propranolol Improves Bulbar Dysfunction Seen in Hyperthyroidism

Abstract Background Many symptoms of hyperthyroidism are mediated by the augmented activity of the adrenergic central nervous system. Rarely, symptoms of bulbar dysfunction are seen with thyrotoxicosis such as dysphagia and dysarthria. Beta blockers can abort or reduce these symptoms before anti-thyroid drugs are used. Case A 59-year-old woman with hypertension and gout, presented to the emergency department with poor oral intake and difficulties swallowing. Symptoms initially started as hoarseness of voice for 3 weeks then progressed to Globus sensation, difficulties swallowing and aspiration of solids and liquids. She also reported generalized muscle weakness, palpitations, increased sweating, tremors and 20 pounds weight loss in the preceding 2 months. Physical exam showed an ill-appearing, catechetic woman. Luedde exophthalmometry showed an absence of proptosis measuring 15 mm bilaterally without lid lag or stare and extraocular muscles were intact. The skin was silky without edema. The strength in the lower extremities was decreased and she was unable to squat or raise from a seated position. Labs showed creatinine of 2.7 mg/dL (0.4–1 mg/dL), BUN 49 (6–20 mg/dL), potassium of 3.1 (3.5–5.1 mmol/L), TSH < 0.02 (0.34–5.60 uIU/mL), FT4: 3.72. CT of the neck was obtained and multiple sub-centimetric hypodense thyroid nodules with calcifications were noted in the left thyroid lobe. Intravenous potassium chloride was given without improvement of dysphagia. 10 milligrams (mg) of propranolol were ordered to be given every 8 hours. After the first dose and over the next 24 hours she reported rapid improvement in dysphagia and muscle weakness. She was discharged on 15 mg of methimazole twice daily and propranolol 10 mg thrice daily. TSI and TRAB were elevated at 1.03 (normal < 0.54 IU/L) and 2.20 (normal<1.75 IU/L) respectively and the diagnosis of Graves’ disease was made. At her 3 weeks follow up, TSH was <0.02 (0.34–5.60 uIU/mL) with normal FT4. She reported complete resolution of dysphagia and improvement in lower extremities weakness. Discussion Hyperthyroidism may exert powerful effects on the neuro-muscular system. The pathogenesis of myopathy in hyperthyroidism is not fully understood. In hyperthyroid periodic paralysis, hypokalemia is present, and paresis is corrected with potassium supplementation. Our patient's symptoms did not improve with potassium supplement but dramatically improved after propranolol use and before the thyroid function was normalized. This implies a role of adrenergic overactivity in myopathy of hyperthyroidism. A study1 was conducted to quantify muscular weakness in hyperthyroidism and assess the response to therapy concluded that propranolol improves muscular weakness. Conclusion Prior to normalization of thyroid function, the use of beta blockers can alleviate symptoms of bulbar dysfunction. (1)Olson BR, Klein I, Benner R, Burdett R, Trzepacz P, Levey GS. Hyperthyroid myopathy and the response to treatment. Thyroid. 1991;1(2): 137-41. doi: 10.1089/thy.1991.1.137. PMID: 1688015. Presentation: Saturday, June 11, 2022 1:00 p.m. - 3:00 p.m.

PSAT286 A Rare Case of Papillary Thyroid Cancer of the Thyroglossal Duct Cyst with Benign Thyroid

Abstract Introduction While the thyroglossal duct cyst (TGDC) is the most commonly seen midline neck mass, thyroglossal duct cyst carcinoma is rare (1-2%) with only a few hundred cases published in the literature. The disease can be challenging to diagnose and treat because most TGDC carcinoma are diagnosed post-operatively and data is limited regarding the extent of surgical resection, adjuvant therapy and long-term outcomes. We report a case of papillary thyroid carcinoma arising from TGDC without any evidence of disease in the thyroid gland. Case Report A 31-year-old male presented with complaints of progressively worsening dysphagia and weight loss for 4 months. An initial CT neck with contrast revealed a soft tissue mass along the anterior aspect of the thyroid cartilage measuring 3.4×2.0×2.2 cm that extended anteriorly from the base of the tongue, favoring a thyroglossal duct cyst. The thyroid gland appeared normal on this imaging. He was given a 2-week course of antibiotics and pantoprazole with no improvement in his symptoms. He underwent a thyroid ultrasound, which showed a large hypoechoic mass, partially cystic, anterior to thyroid. FNA of the TGDC was suspicious for papillary thyroid cancer. Follow-up CT scan redemonstrated known TGDC with increased size of adjacent lymph nodes, concerning for metastasis. Given FNA results, regional lymph node involvement, and the patient's symptoms, he underwent successful Sistrunk procedure for TGDC removal. He declined to wait for intraoperative frozen pathology and opted to discuss pathology and next steps after surgery. Pathology of the TGDC confirmed papillary thyroid cancer (conventional type) with uninvolved margins and metastasis to one of four lymph nodes with the largest lymph node being 7 mm. At the tumor board conference, it was recommended he further undergo a total thyroidectomy with possible post-operative radioactive iodine (RAI) treatment. He underwent a total thyroidectomy, and pathology showed benign thyroid gland with a few colloid cysts. Post-operatively, he was started on levothyroxine. He did not have any improvement in dysphagia following both surgeries. After extensive discussion of the risks and benefits of RAI, the patient chose to defer RAI treatment until further evaluation of his dysphagia was completed. Ultimately, the decision was made to monitor with serial ultrasounds and thyroglobulin levels. Conclusion Optimal treatment of TGDC carcinoma is debatable. A Sistrunk procedure involving resection of cyst plus mid-portion of hyoid bone is universally recommended for adequate excision of the cyst. However, no clear consensus guidelines exist for further management with total thyroidectomy and/or post-operative RAI. Total thyroidectomy permits excision of unsuspected thyroid carcinomas and enables a better follow-up. However, decisions can vary based on extent of disease, tumor characteristics, demographics, and patient preferences. Management decisions should be made on an individualized basis, using a multidisciplinary and shared decision-making approach. Presentation: Saturday, June 11, 2022 1:00 p.m. - 3:00 p.m.

Clinical and financial outcomes of per-oral endoscopic myotomy compared to laparoscopic heller myotomy for treatment of achalasia.

Previous studies analyzing short-term outcomes for per-oral endoscopic myotomy (POEM) have shown excellent clinical response rates and shorter operative times compared to laparoscopic Heller myotomy (LHM). Despite this, many payors have been slow to recognize POEM as a valid treatment option. Furthermore, comparative studies analyzing long-term outcomes are limited. This study compares perioperative and long-term outcomes, cost-effectiveness, and reimbursement for POEM and LHM at a single institution. Adult patients who underwent POEM or LHM between 2014 and 2021 and had complete preoperative data with at least one complete follow up, were retrospectively analyzed. Demographic data, success rate, operative time, myotomy length, length of stay, pre- and postoperative symptom scores, anti-reflux medication use, cost and reimbursement were compared. 58 patients met inclusion with 25 undergoing LHM and 33 undergoing POEM. There were no significant differences in preoperative characteristics. Treatment success (Eckardt ≤ 3) for POEM and LHM was achieved by 88% and 76% of patients, respectively (p = 0.302). POEM patients had a shorter median operative time (106min. vs. 145min., p = 0.003) and longer median myotomy length (11cm vs. 8cm, p < 0.001). All LHM patients had a length of stay (LOS) ≥ 1day vs. 51.5% for POEM patients (p < 0.001). Both groups showed improvements in dysphagia, heartburn, regurgitation, Eckardt score, GERD HRQL, RSI, and anti-reflux medication use. The improvement in dysphagia score was greater in patients undergoing POEM (2.30 vs 1.12, p = 0.003). Median hospital reimbursement was dramatically less for POEM ($3,658 vs. $14,152, p = 0.002), despite median hospital costs being significantly lower compared to LHM ($2,420 vs. $3,132, p = 0.029). POEM is associated with a shorter operative time and LOS, longer myotomy length, and greater resolution of dysphagia compared to LHM. POEM costs are significantly less than LHM but is poorly reimbursed.

S369 Dysphagia From an Ischemic Colonic Segment in a Patient With Colon Interposition

Introduction: Colon interposition of the esophagus in adults may lead to future complications including chronic ischemia, stricture formation, and adenocarcinoma. Case Description/Methods: A 39-year-old male immigrant presented with progressive dysphagia, in the setting of a remote history of emergent colon interposition following gunshot wounds of the esophagus. In the prior 6 months, he developed dysphagia with solids and then liquids, with associated weight loss and regurgitation. On admission, he had stable vitals with an unremarkable physical exam and labs. Esophagram revealed a severe high-grade, upper-mid esophageal stricture with proximal dilation (Figure 1A). Computed Tomography (CT) imaging showed an esophageal conduit in the anterior mediastinum with proximal conduit distension and distal conduit narrowing (Figure 1B). Esophagoduodenoscopy (EGD) revealed a stricture (6 mm) at the esophago-colonic anastomosis, 19 cm from the incisors (Figure 1C). This was traversed with an ultra-thin endoscope which also revealed a severe stenosis distally in the colon segment with a partially obstructing inflammatory polyp. The proximal stricture was dilated in a staged fashion to advance the upper endoscope to the colonic stenosis. A wire was advanced and the stenosis length was estimated to be 11 cm under fluoroscopy. This was successfully stented with 20 mm x 12 cm covered metal stent. The stent was removed one month following the procedure with initial improvement in dysphagia and a normalized diet. However, the patient had re-occurring symptoms and a repeat EGD with dilation and stenting was performed one week later. The multidisciplinary team recommended definitive treatment for the chronic ischemic segment-related complications. Discussion: Conduit ischemia with anastomotic strictures can occur in patients with a history of colonic interposition. Evaluation with double contrast studies may reveal ischemic changes including loss of haustration and stricture formation in the colon graft with dilation being an effective treatment. Chronic ischemia can be a delayed complication of the interposed colon resulting from non-necrotic vascular insufficiency leading to fibrosis, stricture formation, and dysphagia. Additionally, given the patient’s stricture and mass, there was concern for underlying malignancy, which highlights the utility of adenocarcinoma screening in this patient population. Watch the video at https://tinyurl.com/ACGAbstractS369Figure 1.: 1A: Esophagram showing severe high-grade stricture at the junction of the cranial one third and distal two thirds of the esophagus. 1B: CT chest showing conduit extending along anterior mediastinum and deep into the sternum with anastomosis in upper neck and abrupt caliber change in mid esophageal conduit at level of right main pulmonary artery with associated wall thickening, fat stranding, and small adjacent lymph nodes measuring up to 5mm (red arrow). 1C: Esophago-colonic anastomosis found in the middle/lower third of the esophagus at 29cm from incisors.

S399 Dupilumab Treatment Leads to Rapid and Sustained Improvements in Dysphagia

S399 Dupilumab Treatment Leads to Rapid and Sustained Improvements in Dysphagia

S2417 A Diagnosis That Is Difficult to Swallow: Digging Deeper for Answers

Introduction: Esophageal parakeratosis (EP) is an uncommon finding with largely unknown clinical implications and malignant potential. Here, we report a case of severe esophageal parakeratosis. Case Description/Methods: Patient is a 69-year-old African American male with history significant alcohol and cocaine abuse, prior tobacco abuse, keloids, gastroesophageal reflux, food impaction, and progressive dysphagia for 20 years with 40-pound weight loss. Patient’s first esophagogastroduodenoscopy (EGD) in 2000 revealed moderate esophagitis and a distal esophageal stricture with 9 mm lumen bougie dilated to 12 mm, but dysphagia persisted. Repeat EGDs between 2006 and 2016 showed whitish plaques with no evidence of fungal organisms. Given classic appearance of EOE, he was trialed on empiric fluticasone and budesonide with no improvement in dysphagia. In September 2021, he was hospitalized with severe dysphagia. EGD (Figure) at this time showed gray, yellow frondlike lesion replacing esophageal lumen from mid to distal esophagus with mucosal friability. His dysphagia transiently responded to repeat dilations, but continued to recur and worsen. Unfortunately, patient continued to have weight loss and dysphagia unresponsive to dilations. The patient was then started on gastric tube feedings. He was offered surgery due to the severity of his symptoms, but he declined. Most recently, the patient underwent endoscopic mucosal resection with deeper tissue samples revealing superficial fragments of laterally spreading squamous cell carcinoma of the esophagus. Discussion: In this case, there was a high clinical suspicion for malignancy, leading the endoscopist to obtain deeper tissue samples via endoscopic mucosal resection as superficial fragments of the esophagus only revealed parakeratosis. It is important to trust clinical judgment, especially if there is a high suspicion for malignancy. Tylosis also has a known association with EP and often presents with areas of thickened skin plaques on palms and feet. Tylosis has a strong association with head, neck, and esophageal squamous cell carcinoma. The patient had no family history of tylosis and no cutaneous features. Despite this, a careful inspection of the entire EP area with targeted biopsies should be obtained to evaluate for dysplasia. This case represents EP with years of no evidence of squamous cell cancer despite aggressively searching for it, which at least anecdotally suggests a precancerous potential for EP.Figure 1.: A. Initial EGD B. Recent EGD.

Anti-reflux versus conventional self-expanding metal stents in the palliation of esophageal cancer: A systematic review and meta-analysis.

Background and study aims Self-expanding metal stents (SEMS) are an effective palliative endoscopic therapy to reduce dysphagia in esophageal cancer. Gastroesophageal reflux disease (GERD) is a relatively common complaint after non-valved conventional SEMS placement. Therefore, valved self-expanding metal stents (SEMS-V) were designed to reduce the rate of GERD symptoms. We aimed to perform a systematic review and meta-analysis comparing the two stents. Material and methods This was a systematic review and meta-analysis including only randomized clinical trials (RCT) comparing the outcomes between SEMS-V and non-valved self-expanding metal stents (SEMS-NV) following the Preferred Reporting Items for Systematic Reviews and Meta-analysis guidelines. The risk of bias was assessed using the Cochrane Risk of Bias 2 tool. Data were analyzed with Review Manager Software. Quality of evidence was evaluated using Grading of Recommendations Assessment, Development, and Evaluation guidelines. Results Ten randomized clinical trials including a total of 467 patients, 234 in the SEMS-V group and 233 in the SEMS-NV group, were included. There were no statistically significant differences regarding GERD qualitative analysis (RD –0.17; 95 % CI –0.67, 0.33; P = 0.5) and quantitative analysis (SMD –0.22; 95 % CI –0.53, 0.08; P = 0.15) technical success (RD –0.03; 95 % CI –0.07, 0.01; P = 0.16), dysphagia improvement (RD –0.07; 95 % CI –0.19, 0.06; P = 0.30), and adverse events (RD 0.07; 95 % CI –0.07, 0.20; P = 0.32). Conclusions Both SEMS-V and SEMS-NV are safe and effective in the palliation of esophageal cancer with similar rates of GERD, dysphagia relief, technical success, adverse events, stent migration, stent obstruction, bleeding, and improvement of the quality of life.

Phase I trial of hypofractionated chemoradiotherapy in the palliative management of esophageal and gastro-esophageal cancer

BackgroundMany patients with incurable esophageal cancer (ECa) present with dysphagia as their predominant symptom. Currently there is no consensus on how best to initially manage this scenario with multiple therapeutic options available. We aimed to assess the safety and efficacy of using hypofractionated radiotherapy given over a progressively shorter timeframe with concurrent carboplatin and paclitaxel in the management of patients with ECa and dysphagia.MethodsIn this phase I trial we enrolled patients with histologically proven squamous cell carcinoma or adenocarcinoma of the esophagus or the gastro-esophageal junction with symptomatic dysphagia from local disease and not for curative treatment. Patients needed to be 18 years or older, have an ECOG performance status of 0–2 and be suitable to receive carboplatin and paclitaxel chemotherapy. Patients were placed in four progressively shorter radiation schedules culminating in 30 Gy in 10 fractions in a step wise manner, all with concurrent carboplatin AUC 2 and paclitaxel 50 mg/m2 chemotherapy delivered weekly with the radiation therapy. The primary endpoint was the development of the dose limiting toxicities (DLTs) esophageal perforation or febrile neutropenia. Secondary endpoints were relief of dysphagia, time to improvement of dysphagia, dysphagia progression free survival and overall survival.ResultsEighteen patients were enrolled in the study between October 2014 and March 2019. There were no DLTs experienced during the trial. The most common grade 3 + acute toxicity experienced by patients were nausea and vomiting (both in 4/18 patients). The most common radiation specific acute toxicity experienced was esophagitis with 67% of patients experiencing grade 1–2 symptoms. All patients experienced improvement in dysphagia. The median time to dysphagia improvement was 3 weeks from the start of chemoradiotherapy (CTRT) (range 2–10 weeks). The median dysphagia free survival was 5.8 months with a median overall survival of 8.9 months.ConclusionHypofractionated palliative CTRT with 30 Gy/10# of radiation therapy with concurrent weekly carboplatin and paclitaxel chemotherapy is well tolerated and provides a good response in improvement of dysphagia. Further studies need to be undertaken which provide both symptomatic improvement in the primary tumor but also control of the metastatic burden in these patients.Clinical Trial Registration: This trial was prospectively registered with www.anzctr.org.au Identifier: ACTRN12614000821695.

A case of significant weight loss and severe malnutrition caused by achalasia

Achalasia is caused by chronic degeneration of ganglionic cells in the myenteric plexus that leads to failure of relaxation of the lower esophageal sphincter (LES). This leads to aperistalsis of the digital esophagus and eventually led to dilation of the lower esophagus. We present the case of a 37-year-old man who initially presented with dysphagia for solid food and then slowly developed dysphagia for liquid over the past 6 months. He had significant weight loss, and his esophagogastroduodenoscopy (EGD) showed esophagitis and gastritis. The imaging of computed tomography (CT) with oral contrast showed dilation of the distal esophagus and mild circumferential thickening at the gastroesophageal junction. After the failure of response to BoTox-infiltration in the LES, the patient was taken for Heller’s myotomy. He showed immediate improvement in dysphagia after surgical intervention. This case study includes findings from CT scan, X-ray, and EGD with biopsies in this patient. This paper also summarizes the therapeutic options of BoTox-injection and surgical myotomy

Improvement of Post-stroke Dysphagia by Intermittent Theta Burst Stimulation

The present study aims to investigate the efficacy of intermittent theta burst stimulation (iTBS) on post-stroke dysphagia and its effect on the motor cortical excitability of the suprahyoid muscle. A total of 40 patients with post-stroke dysphagia were randomly divided into the iTBS and the sham stimulation groups, with the conduction of motor cortical iTBS and sham stimulation of the supraglottal muscle on the affected side, respectively. Swallowing function was assessed before (T0), immediately after (T1), and two weeks after (T2) cessation of the intervention using the water-swallowing test (WST), standard swallowing assessment (SSA), Murray secretion scale (MSS), and Penetration–Aspiration Scale (PAS). The bilateral motor evoked potentials (MEP) of the suprahyoid muscle were recorded. After the intervention, the PAS, WST, SSA, and MSS scores were significantly improved in both groups (p &lt; 0.05). The iTBS group showed a greater change in the PAS score than the sham stimulation group at T1 (p &lt; 0.05) and a greater change in the WST and MSS scores at T2 (p &lt; 0.05). The amplitude of the MEP wave of the suprahyoid muscle in the affected hemisphere was significantly higher in the iTBS group at T1 and in the healthy hemisphere at T2 (p &lt; 0.05). The feasibility of applying iTBS to the affected hemisphere for the treatment of post-stroke dysphagia was directly analyzed for the first time. ITBS combined with conventional swallowing therapy could be adopted as a rehabilitation strategy to improve post-stroke dysphagia.

Peroral cricopharyngeal myotomy for the management of Zenker's diverticulum in the hands of a general surgeon.

The treatment of Zenker's diverticulum has been shifted from open cricopharyngeal myotomy and rigid endoscopy to the use of flexible endoscopy. Few studies evaluate general surgeon's performance of flexible endoscopic management of Zenker's diverticulum as the majority are performed by gastroenterologists. The objective of our case series is to show that general surgeons trained in surgical endoscopy can perform this procedure with favorable outcomes. A retrospective review of peroral cricopharyngeal myotomies performed at Spectrum Health hospital in Grand Rapids, Michigan by a single surgical endoscopist between the 2018 and 2021 was conducted. The primary outcome was the improvement of dysphagia. Intra-procedural complications, post-procedural complications, hospital length of stay, time to oral intake, and recurrence were also evaluated. Age, sex, body mass index, diverticulum size, and procedure time were abstracted. Median (ranges) and frequencies (percentages) are used to describe the patient population and outcomes. Forty patients were included in the study. Median age was 74years old (60-95) with a male predominance (n = 27, 67.5%). Median BMI was 28kg/m2 (18-43), average procedure length of 64min (41-119), diverticulum size of 28mm (19-90), and average length of stay of 0.9days (0-8). There were no intra-procedural complications. All patients had a post-procedural esophagram prior to initiation of diet. Esophageal leak was the only complication that occurred, which was found on post-procedural esophagram (n = 5). Only two patients had clinical sequelae. All leaks closed without additional surgical intervention. The majority of patients had their diet resumed and discharged the same day of the procedure. Frequency of recurrence was 17.5% (n = 7). Our study demonstrates that general surgeons trained in endoscopy can perform endoscopic myotomies for Zenker's diverticula on a wide range of sizes, with favorable patient outcomes, and few complications.

Effectiveness of Endoscopic Dilatation for Corrosive Oesophageal Strictures

Objective: The objective of study was to determine the efficacy after endoscopic dilatation in patients of corrosive intake. Study Design: It was descriptive case series Setting: Research was conducted at Medical Unit-III, Services Hospital, Lahore. Duration: Duration of study was 6 months from 1st November 2016 to 30th April 2017. Material and Methods: This study involved 150 patients of age 18-65 years with corrosive intake and dysphagia score ≥ 2. A written informed consent was taken from each patient. Results: Total 150 patients were added in the study. Out of these, 118 patients (78.7%) were females while 32 (21.3%) were males. The age of patient ranged from 18 to 48 years with a mean of 26.72 ±5.61. One hundred thirty two patients (88 %) showed improvement in dysphagia while 18 patients (12 %) did not show any improvement. Efficacy calculated by chi- square test which showed p-value of .000 (statistically significant) Conclusion: 150 patients with dysphagia score ≥ 2 were added in study and dilated with Savary-Gilliard dilator. 132 patients showed improvement in dysphagia with p-value of .ooo (statistically significant).

Assessment of gene expressions from squamous cell carcinoma of the head and neck to predict radiochemotherapy-related xerostomia and dysphagia

Purpose We tested the hypothesis that gene expressions from biopsies of locally advanced head and neck squamous cell carcinoma (HNSCC) patients can supplement dose-volume parameters to predict dysphagia and xerostomia following primary radiochemotherapy (RCTx). Material and methods A panel of 178 genes previously related to radiochemosensitivity of HNSCC was considered for nanoString analysis based on tumour biopsies of 90 patients with locally advanced HNSCC treated by primary RCTx. Dose-volume parameters were extracted from the parotid, submandibular glands, oral cavity, larynx, buccal mucosa, and lips. Normal tissue complication probability (NTCP) models were developed for acute, late, and for the improvement of xerostomia grade ≥2 and dysphagia grade ≥3 using a cross-validation-based least absolute shrinkage and selection operator (LASSO) approach combined with stepwise logistic regression for feature selection. The final signatures were included in a logistic regression model with optimism correction. Performance was assessed by the area under the receiver operating characteristic curve (AUC). Results NTCP models for acute and late xerostomia and the improvement of dysphagia resulted in optimism-corrected AUC values of 0.84, 0.76, and 0.70, respectively. The minimum dose to the contralateral parotid was selected for both acute and late xerostomia and the minimum dose to the larynx was selected for dysphagia improvement. For the xerostomia endpoints, the following gene expressions were selected: RPA2 (cellular response to DNA damage), TCF3 (salivary gland cells development), GBE1 (glycogen storage and regulation), and MAPK3 (regulation of cellular processes). No gene expression features were selected for the prediction of dysphagia. Conclusion This hypothesis-generating study showed the potential of improving NTCP models using gene expression data for HNSCC patients. The presented models require independent validation before potential application in clinical practice.

Calf circumference and stroke are independent predictors for an improvement in the food intake level scale in the Japanese sarcopenic dysphagia database.

The purpose of this study was to use the food intake level scale (FILS) to clarify whether calf circumference (CC) and stroke contribute to an improvement of inpatient dysphagia. We used the Japanese sarcopenic dysphagia database (n = 467) to analyze FILS data recorded at admission and after follow-up in 322 cases. A multivariate analysis was performed to determine whether CC and stroke improved the FILS by two points or more. The patient characteristics were as follows: 177 (55%) men; median age, 81years; median body mass index, 20.3kg/m2; median CC, 28.2cm; presence of sarcopenic dysphagia, 183 (56.8%); history of stroke, 103 (32%); median FILS on admission (interquartile range (IQR)), 6 (2-7); and median FILS at the end of the observation (IQR), 7 (7-8). Comparison of FILS at admission and discharge showed that 137 patients had an improvement in the scale of two points or more, whereas 185 patients had no improvement. Multivariate logistic regression analysis showed the factors that were associated independently with an improvement in dysphagia were: age < 80years (odds ratio (OR) 2.20, 95% confidence interval (CI) 1.36-3.54, p = 0.001); CC ≥ 29.4cm (OR 2.19, 95% CI 1.33-3.61, p = 0.002); sex (OR 1.67, 95% CI 1.03-2.71, p = 0.037); and stroke (OR 1.85, 95% CI 1.09-3.16, p = 0.023). Our results suggest that a CC ≥ 29.4cm and history of stroke contributed to an improvement of inpatient dysphagia at discharge. The contribution of the easy-to-measure CC to predict an improvement in swallowing function may be very useful in daily clinical practice.