Postsurgical Dysphagia Research Articles

OGBN P36 Surgical Consideration in Patients with Ineffective Oesophagus: Implications for Low Risk of Dysphagia and Suitability for Antireflux Operation

Abstract Background Ineffective oesophageal motility (IOM) is a minor motility disorder that is commonly found in patients. The IOM diagnosis is based on heterogenous combination of failed peristalsis, weak peristalsis activity and peristaltic defects that are observed during the stimulation to 5mL standard water swallows. IOM is implicated to post-surgical dysphagia and therefore influences the surgical decision making. This paper will address this topic. Methods A retrospective review was conducted on patients who underwent oesophageal high-resolution manometry (HRM) between March and May 2023. The diagnosis of IOM was based on the international Chicago Classification guideline (version 4.0). Patients' oesophageal motility profiles were assessed for peristaltic reservation (PR) and oesophageal contractile mean wave amplitude (MWA). PR >100% in IOM patients indicates low risk of dysphagia after laparoscopic Nissen fundoplication (LNF). Similarly, normal MWA indicate a low risk of dysphagia in considering patients for Magnetic Sphincter Augmentation (MSA). Results 120/270 patients (44.4%) were diagnosed with IOM (female:male=86:34, median age 52 years old). Mean PR in IOM patients was 217.8% [95%CI:181.2%-254.4%] with 60.8% demonstrating PR >100%. Average MWA found in IOM patients was 40.8mmHg (95%CI:38.5mmHg-43.1mmHg) with 38.3% demonstrating normal MWA. 13.3% (16/120) of patients did not invoke peristalsis on MWS, but 6 of the 16 patients showed normal MWA. 24.2% (29/120) patients demonstrated PR >100% and normal MWA. 14.2% (17/120) of patients showed adequate PR and weak MWA and pose risk of postsurgical dysphagia. 75% (90/120) of patients with IOM were suitable for at least one antireflux operation. Conclusions Approximately half of the oesophageal physiology patients have IOM and three-quarters of these patients are suitable for at least one form surgical intervention with low risk postsurgical dysphagia. Only 14.2% of patients with IOM pose a risk of post-surgical dysphagia. The overall findings suggests that surgical intervention may be a viable option for patients with IOM that could potentially improve their quality of life and prevent reflux oesophagitis/pre-cancerous Barrett’s oesophagus. This study was limited by not investigating the relationship between IOM pathophysiology and the reflux oesophagitis severity grade.

Anxiety and depression in patients with post-surgical dysphagia in Sri Lanka

The Sri Lanka Journal of Psychiatry (SLJP) is a peer-reviewed, open access journal published bi annually by the Sri Lanka College of Psychiatrists.The Journal publishes original papers, brief reports including case reports and commentaries relevant to psychiatry and allied sciences. The Sri Lanka Journal of Psychiatry is committed to maintaining and conforming to the editorial and ethical standards recommended by the International Committee of Medical Journal Editors.Cover“Perseverance”. These tenacious fishermen in Mannar continue their livelihood despite numerous difficulties. L. N. P. Samarasinghe, Acting Consultant Psychiatrist, Base Hospital Nikaweratiya, Sri Lanka.

Swallowing Outcomes Following Supraglottoplasty: A Retrospective Review

Determine the incidence of short- and long-term dysphagia in pediatric patients with and without syndromes/neurodevelopmental delay following supraglottoplasty (SGP) at our institution. Retrospective cohort study. A retrospective cohort study of children ≤18 years old who underwent SGP from 2014 to 2019 was undertaken. Age at surgery, sex, race, insurance, underlying syndromes/neurodevelopmental delay, concurrent surgical procedures, and clinical swallowing assessments were reviewed. Logistic regression was performed to identify factors associated with postoperative feeding difficulties. Time-to-event analysis was performed to assess time to resolution of dysphagia. A total of 231 patients were identified. Average age at time of SGP was 13.7 months. Of 231 patients, 88 (38.1%) had a syndrome/neurodevelopmental delay. Of these 231 patients, 112 had a preoperative videofluoroscopic swallow study or fiberoptic endoscopic evaluation of swallowing, of whom 53/112 (47.3%) had dysphagia. After SGP, 138/231 (59.7%) underwent clinical/instrumental swallowing assessments, of whom 95/138 (68.8%) had immediate postsurgical dysphagia. At last follow-up (1 month to 45 months), 15/95 (15.8%) had persistent dysphagia on instrumental assessment, 14/15 of whom had syndromes/neurodevelopmental delay. Time-to-event analysis revealed that for the nonsyndromic cohort, 25% had resolution of dysphagia by 4 months, 50% by 10 months, and 75% by 14 months. Cox proportional hazards regression revealed that the presence of underlying syndromes/neurodevelopmental delay was the only factor predictive of long-term postoperative dysphagia (hazard ratio of resolution 0.21 [95% confidence interval 0.096-0.48]). While short-term feeding difficulties following SGP in pediatric patients are not uncommon, long-term dysphagia is rare in patients without syndromes/neurodevelopmental delay. These data can be used when counseling caregivers about the risks and benefits of SGP. 4 Laryngoscope, 131:2817-2822, 2021.

Pre- and Post-Surgical Dysphagia in Adults with Tumors of the Posterior Fossa: A Prospective Blinded Study.

Simple SummaryDysphagia is a known complication of posterior fossa tumor resection, but data regarding risk factors and clinical course are sparse, in particular in adults. The purpose of this study was to investigate frequency, severity and outcome of swallowing disorders in adults undergoing PFT-surgery to improve presurgical counseling and postsurgical therapeutic care. Our findings demonstrate that dysphagia is a frequent finding before and after surgery putting patients at risk for aspiration and pneumonia. We provide clinical predictors which might be helpful in identifying dysphagic patients in order to determine the safest feeding route. This might lead to both improvement of outcome and reduction of medical complication.Background: While swallowing disorders are frequent sequela following posterior fossa tumor (PFT) surgery in children, data on dysphagia frequency, severity, and outcome in adults are lacking. The aim of this study was to investigate dysphagia before and after surgical removal of PFT. Additionally, we tried to identify clinical predictors for postsurgical swallowing disorders. Furthermore, this study explored the three-month outcome of dysphagic patients. Methods: In a cohort of patients undergoing PFT surgery, dysphagia was prospectively assessed pre- and postoperatively using fiberoptic endoscopic evaluation of swallowing. Patients with severe dysphagia at discharge were re-evaluated after three months. Additionally, clinical and imaging data were collected to identify predictors for post-surgical dysphagia. Results: We included 26 patients of whom 15 had pre-operative swallowing disorders. After surgery, worsening of pre-existing dysphagia could be noticed in 7 patients whereas improvement was observed in 2 and full recovery in 3 subjects. New-onset dysphagia after surgery occurred in a minority of 3 cases. Postoperatively, 47% of dysphagic patients required nasogastric tube feeding. Re-evaluation after three months of follow-up revealed that all dysphagic patients had returned to full oral intake. Conclusion: Dysphagia is a frequent finding in patients with PFT already before surgery. Surgical intervention can infer a deterioration of impaired swallowing function placing affected patients at temporary risk for aspiration. In contrast, surgery can also accomplish beneficial results resulting in both improvement and full recovery. Overall, our findings show the need of early dysphagia assessment to define the safest feeding route for the patient.

Efficacy and patient satisfaction of single-session transoral incisionless fundoplication and laparoscopic hernia repair.

Transoral incisionless fundoplication (TIF) is an effective endoscopic treatment for refractory GERD with small or absent hiatal hernia (<2cm in length and width). The single-session laparoscopic hernia repair followed by transoral incisionless fundoplication (HH+TIF) aims to repair mechanical defects in the lower esophageal sphincter that leads to GERD in patients with hiatal hernias≥2cm. The procedure effectively treats GERD without causing added post-surgical dysphagia and gas bloating commonly associated with partial laparoscopic fundoplication. We aimed to assess patient satisfaction, symptom resolution, safety, and proton pump inhibitor use following the HH+TIF procedure. Thirty-three patients underwent single-session laparoscopic hernia repair with intraoperative TIF using the EsophyX Z device (EndoGastric Solutions, Inc.) between June 2015 and June 2018. The presence of GERD and normal esophageal motility were confirmed with pH testing and manometry prior to the procedure. Data were collected on pre- and post-procedure symptoms, patient satisfaction, PPI use, and complications. Median post-procedure follow-up with symptom surveys was 9months (11-29months). Patients reported significant decreases in common GERD symptoms including heartburn, regurgitation, cough, and hoarse voice. Eighty-one percent (27/33) of patients were off daily PPIs. Ninety-four percent (31/33) of patients reported 75% or greater satisfaction with the procedure and outcomes. One patient had a superficial mucosal laceration after the procedure, likely due to vomiting, which was treated conservatively. The majority of patients reported 75% or greater satisfaction with the procedure and had an improvement in GERD symptoms as well as decreased PPI use. There were no serious adverse events.

Pre- and Postsurgical Dysphagia and Outcome in Adults with Posterior Fossa Tumor: A Prospective, Blinded Study

Pre- and Postsurgical Dysphagia and Outcome in Adults with Posterior Fossa Tumor: A Prospective, Blinded Study

Prophylactic Measures and Intervention for Post-surgical Dysphagia After Anterior Cervical Discectomy and Fusion

Prophylactic Measures and Intervention for Post-surgical Dysphagia After Anterior Cervical Discectomy and Fusion

Fat injection under local anesthesia in the treatment of chronic postsurgical dysphagia

Fat injection under local anesthesia in the treatment of chronic postsurgical dysphagia

Patient-reported outcome measures in dysphagia: a systematic review of instrument development and validation.

Patient-reported outcome (PRO) measures are commonly used to capture patient experience with dysphagia and to evaluate treatment effectiveness. Inappropriate application can lead to distorted results in clinical studies. A systematic review of the literature on dysphagia-related PRO measures was performed to (1) identify all currently available measures and (2) to evaluate each for the presence of important measurement properties that would affect their applicability. MEDLINE via the PubMed interface, the Cumulative Index of Nursing and Allied Health Literature, and the Health and Psychosocial Instrument database were searched using relevant vocabulary terms and key terms related to PRO measures and dysphagia. Three independent investigators performed abstract and full text reviews. Each study meeting criteria was evaluated using an 18-item checklist developed a priori that assessed multiple domains: (1) conceptual model, (2) content validity, (3) reliability, (4) construct validity, (6) scoring and interpretation, and (7) burden and presentation. Of 4950 abstracts reviewed, a total of 34 dysphagia-related PRO measures (publication year 1987-2014) met criteria for extraction and analysis. Several PRO measures were of high quality (MADS for achalasia, SWAL-QOL and SSQ for oropharyngeal dysphagia, PROMIS-GI for general dysphagia, EORTC-QLQ-OG25 for esophageal cancer, ROMP-swallowing for Parkinson's Disease, DSQ-EoE for eosinophilic esophagitis, and SOAL for total laryngectomy-related dysphagia). In all, 17 met at least one criterion per domain. Thematic deficiencies in current measures were evident including: (1) direct patient involvement in content development, (2) empirically justified dimensionality, (3) demonstrable responsiveness to change, (4) plan for interpreting missing responses, and (5) literacy level assessment. This is the first comprehensive systematic review assessing developmental properties of all available dysphagia-related PRO measures. We identified several instruments with robust measurement properties in multiple diseases including achalasia, oropharyngeal dysphagia, post-surgical dysphagia, esophageal cancer, and dysphagia related to neurological diseases. Findings herein can assist clinicians and researchers in making more informed decisions in selecting the most fundamentally sound PRO measure for a given clinical, research, or quality initiative.

A review of postsurgical dysphagia in nonmalignant disease.

This article reviews current literature regarding postsurgical dysphagia in nonmalignant disease examining the current recommendations, risk factors, and potential implications. Surgical interventions including anterior cervical spine surgery, thyroidectomy, laryngeal and pulmonary, cardiac, esophageal and fundoplication, gastric and bariatric, and posterior fossa surgeries are known to result in swallowing dysfunction. Postsurgical dysphagia may increase the length of hospitalization, overall cost, risk of pneumonia, and time to oral intake. There are limited prospective research studies examining postsurgical dysphagia and poorly understood causes. The results are unclear regarding severity, symptom type, duration, and treatment outcomes of postsurgical dysphagia. The life-changing and life-threatening nature of dysphagia make this an important factor to consider and discuss with patients and families. Both acute and late-onset dysphagia may become chronic if left untreated. Presurgery and postsurgery swallow studies should be considered for cervical spine, thyroid, lung, gastric, cardiac, and surgeries involving the cranial nerves. Future research should examine postsurgical dysphagia in a prospective manner using established and reliable methods of measurement to parse out causal factors and more accurate prevalence rates for each surgical intervention and population.

Postsurgical dysphagia: evaluation and rehabilitation

Surgical resection of a malignant tumor in the head and neck regions quite often alters the complex act of swallowing. The goal of dysphagia rehabilitation is to return the patient’s swallowing to as near normal as possible. Although surgical procedures in the oral cavity, tongue, pharynx can affect preparation, control and transport of the bolus, functional disorders following laryngeal surgery are most common and severe. The larynx serves two critical functions during swallowing. First, it elevates anteriorly moving itself from the path of the bolus and contributing to the opening of the cricopharyngeal sphincter. Second, it protects the airways from inhaling acting as a three level valve -- the epiglottis, false vocal folds, and true vocal folds. Any surgical intervention affecting this closure will likely results in aspiration during the swallow. Patients undergoing total laryngectomy have few swallowing problems due to the separation of the airways from the esophagus. On the contrary both partial and reconstructive procedures can significantly affect both the respiratory and the alimentary function. Supraglottic laryngectomy can interfere with laryngeal elevation and sometimes with vocal fold adduction especially when the surgical procedure includes portions of the hyoid bone, base of tongue, aryepiglottic folds, or false vocal folds. Vertical laryngectomies reduce laryngeal closure. When the intervention is limited to one focal fold (cordectomy), the swallowing recovery is usually easily achieved. In frontolateral laringectomy the removal of tissues extends to the opposite vocal fold: in such cases swallowing recovery is still possible with a combination of increased effort and compensatory head posturing. In sub-total/reconstructive laryngectomies (Crico-Hyoido-Epiglotto-Pexy, CHEP and Crico-HyoidoPexy, CHP) the surgeon intends to create a neoglottis able to contracts during swallowing. In such cases critical factors in recovery of swallowing are considered the airway closure at the laryngeal entrance, the propulsive movement of the tongue base and its contact with the posterior pharyngeal wall. Two pernicious, life-threatening complications can slowly compromise the patient’s life aspiration, pneumonia and malnutrition. Diagnostic procedures of swallowing disorders are mainly represented by radiographic contrast examination and by fiberoptics endoscopic evaluation. Compensatory treatment strategies include postural changes, increasing sensory input, modifying volume, consistency and viscosity of foods. Rehabilitative procedures are designed to improve a range of movements of oral or pharyngo-laryngeal structures and increase their sensory-motor integration and timing. Exercises and manoeuvres designed to achieve such goals are considered in detail.

Pre and post-surgical dysphagia outcome associated with posterior fossa tumour in children

Swallowing impairment (dysphagia) has been reported as a possible sequela following surgical removal of posterior fossa tumours (PFT). Dysphagia may result in aspiration of food/fluid leading to respiratory tract infection, placing the patient at considerable health risk. No prospective studies have investigated dysphagia pre and post-surgical removal of PFT. The present study aimed to document the presence, severity and characteristics of dysphagia pre and post-surgical resection of PFT, and to determine whether children were managing a normal oral diet (i.e. a measure of functional swallowing ability) at two months post-surgery. Dysphagia was assessed using a clinical bedside evaluation in 11 participants (8 M; aged 3 years 6 months to 13 years 5 months) pre (within 3-5 days) and post-surgery (within 1-2 weeks). Return to normal oral feeding was documented at two months post-surgery via a parent telephone interview. No participant had dysphagia pre-surgically. Seventy three percent (8/11) had dysphagia at 1-2 weeks post-surgery, primarily characterized by impaired lip closure (8/8), poor mastication (8/8), and inefficient oral transit (8/8). Whilst dysphagia severity was largely mild (6/8) in presentation, data suggest that assessment and monitoring of this disorder may be required in the acute phase post-surgery. Overall however, prognosis appeared positive, with 75% (6/8) of participants managing a full oral diet at 2 months post-surgery.

S433: Management of Postsurgical Dysphagia in Oral and Oropharyngeal Cancer Patients

S433: Management of Postsurgical Dysphagia in Oral and Oropharyngeal Cancer Patients

頭頚部癌術後えん下障害患者に対する姿勢調節法の効果―えん下造影画像解析による直立姿勢と健側傾斜姿勢との比較検討―

Postsurgical dysphagia in patients with head and neck cancer is often improved by postural techniques, one procedure for compensatory treatment.This study was done to analyze videofluorographic (VF) images of postsurgical patients with head and neck cancer by comparing upright posture with head tilting posture on the stronger side. Twelve postsurgical patients with head and neck cancer whose aspiration was improved by head tilting posture on the stronger side were studied.The tilting magnitude, vallecular angle, and epiglottic angle were measuredon VF prints. Retained amounts of swallowed barium were evaluated in the oral region, vallecular region, and pyriform sinus on VF images.Pharyngeal delay time, pharyngeal passage time, and pharyngo-esophageal (PE) segment opening time were measured on VF images. The results were as follows:1) There was no correlation between any two of the following three variables: tilting magnitude, vallecular angle, and epiglottic angle.2) The retained amount of swallowed barium swallow in tilting posture on the stronger side was less than that in upright posture in 10 of 12 subjects.3) As compared with upright position, pharyngeal delay time and pharyngeal passage time were shorter in tilting posture on the stronger side.

Cortical representation of swallowing in normal adults: functional implications.

Dysphagia of neurogenic or postsurgical origin presents management and therapeutic challenges to the otolaryngologist. Improvements in management and therapeutic approaches may be facilitated by understanding how the central nervous system controls swallowing. The purpose of this investigation was to utilize functional magnetic resonance imaging to determine patterns of cortical activity during swallowing in normal, healthy adult subjects. Functional magnetic resonance imaging (fMRI) was performed on eight healthy adult subjects using conventional BOLD (blood oxygenation level dependent) techniques. Subjects performed three different swallowing tasks including dry and bolus swallows, and performed a control finger movement task. Statistical maps of cortical activation were generated using a cross-correlation analysis. One-way and two-way ANOVA statistical analyses were performed to compare activated areas among the different tasks and to determine the effects of task sequence. Activation during the three swallowing tasks occurred in the primary motor cortex, primary somatosensory cortex, and other cortical and subcortical sites. Cortical representation of swallowing and finger movement followed somatotopic maps. Differential distribution of cortical activation was observed for the different swallowing tasks. Activation of the primary motor and somatosensory cortices, as well as other sensory-motor areas, occurs with swallowing in normal adults. Differential distribution of cortical activity with different swallowing tasks suggests differential functional organization for different swallowing tasks. Understanding these mechanisms may facilitate improved management and therapeutic intervention for neurogenic and postsurgical dysphagia.

Deglutition disorders

Dysphagia is related to the impairment of food passage from the mouth to the stomach. Globus pharyngis implies the frequent and often painful sensation of a lump in the throat that usually does not interfere with swallowing and may even be relieved by food intake. The diagnosis is based upon a careful history, clinical examination, endoscopy, dynamic imaging (videofluoroscopy, cinematography, videosonography) and electrophysiologic procedures (including pharyngoesophageal manometry, electromyography and pH determinations). Structural lesions of the cervical spine such as diffuse idiopathic skeletal hyperostosis are rare causes of dysphagia. Dysphagia following anterior cervical fusion as well as globus and dysphonia due to dysfunction of the vertebral joints are more likely. Symptoms with swallowing fluids indicate a neurogenic origin. Dyscoordinated swallowing, nasal reflux, dysphonia or general weakness may also occur. Chronic aspiration with respiratory compromize is the main consequence in a variety of neurological disorders as well as in cases of postsurgical dysphagia. Relaxation of the upper esophageal sphincter indicates coordinated muscle movement between the pharynx and esophagus. Dysfunction of the pharyngoesophageal segment may lead to cricopharyngeal achalasia. A dyskinetic sphincter commonly represents an extrapharyngeal cause: i.e., disease associated with gastroesophageal reflux. Disorders of the esophageal phase of deglutition can produce retrosternal pain, heartburn, regurgitation and vomiting, as well as laryngeal and respiratory signs. Esophageal motility disorders include lower achalasia, tumors, peptic strictures, inflammatory diseases, drug-induced ulcers, rings and webs. Motility disorders present with aperistaltic, spontaneous contractions, diffuse esophagospasm, or a hypermotile esophagus. Gastroesophageal reflux with esophagitis must always be excluded, especially in patients with a globus sensation. The multiple features of the appearance of the symptoms of dysphagia and globus makes multidisciplinary approach necessary in order to establish a diagnosis and begin effective treatment.

Persistent Dysphagia and Dysphonia following Cervical Spine Surgery

Persistent dysphagia and dysphonia following anterior cervical spine surgery have been underdiagnosed. Understanding the physiologic mechanism resulting in post-surgical dysphagia and dysphonia is essential to providing appropriate treatment. Two cases of protracted dysphagia and dysphonia following left anterior cervical corpectomy were reviewed. Videofluoroscopic evaluation, videostroboscopic assessment and laryngeal nerve-conduction testing were used to determine swallowing, vocal fold and cranial nerve integrity; to assess the ability to achieve oral nutrition; and to direct therapy and surgical procedures to improve swallowing and voice. With a multidisciplinary approach, the physiologic problems of post-surgical dysphagia and dysphonia can be addressed and therapeutic and/or surgical treatments initiated promptly.

Usefulness and limitation of crico-pharyngeal myotomy and laryngeal suspension after wide resection of the tongue or oropharynx

To prevent post-surgical dysphagia in oral or oropharyngeal cancer patients, crico-pharyngeal myotomy and laryngeal suspension are recommended; however, its indication has been controversial. When it was though that patients would lose the mechanisms of laryngeal elevation or mechanisms to produce oropharyngeal pressure we opted for crico-pharyngeal myotomy and laryngeal suspension: total or subtotal glossectomy with bilateral resection of suprahyoid muscles, and wide resection of the oropharynx including the tongue base. In this paper, we report the usefulness and limitation of crico-pharyngeal myotomy and laryngeal suspension after wide resection of the tongue or oropharynx. From April 1992 to January 1996, 19 patients received circo-pharyngeal myotomys and laryngeal suspensions along with their initial operation for oral or oropharyngeal cancer. Their ages ranged from 28 to 69 years. Fourteen had tongue cancer and 5 had oropharyngeal cancer. We examined the relationship between the ability to have an oral diet and the extent of mobile tongue resection, extent of tongue base resection, and extent of resection of the lateral wall of the oropharynx, reconstruction method, and age. Fifteen of the 19 patients (68%) could have an oral diet when they were discharged. The extent of tongue base resection (more than 50%) and age (> or = 60) significantly affected post-surgical aspiration. Two patients who had total glossectomy with total tongue base resection could have an oral diet. They were 41 and 51 years old. One 35-year-old patient who had total glossectomy with wide tongue base resection (80%) was able to have the same diet as his family. On the other hand, 4 elderly patients (> or = 60) who had wide resection of the tongue base (> or = 50%) could not have an oral diet at all. A crico-pharyngeal myotomy and a laryngeal suspension can contribute to the prevention of post-surgical dysphagia. However, if an elderly patient (> or = 60) has had wide tongue base resection (> = 50%), he may not be able to have an oral diet. In these cases, we have to opt for additional methods, such as total laryngectomy, to prevent aspiration.

Percutaneous endoscopic gastrostomy by head and neck surgeons

The endoscopic placement of percutaneous gastrostomy tubes has been an accepted technique for several years but has traditionally been performed by gastroenterologists and general surgeons. Fluoroscopically guided tube placement is now performed by radiologists. Head and neck surgeons have been slow to adopt the responsibility for placing percutaneous gastrostomy tubes despite the fact that most are proficient in both rigid and flexible esophagoscopy and trained in the Seldinger technique. We report on 41 percutaneous endoscopic gastrostomies performed in 39 patients by the Head and Neck Service at Stanford Medical Center between July 1, 1992, and August 30, 1995. There were 28 (71.8%) male and 11 (28.2%) female patients. Eleven (28.2%) procedures were performed in patients at the time of major head and neck resections. Another seven (17.9%) patients underwent percutaneous gastrostomy tube placement at the time of their initial staging panendoscopy before receiving chemotherapy and radiation. Fifteen (38.5%) procedures were performed for severe postsurgical dysphagia. Six (15.4%) patients had neurologic dysfunction, and this procedure was often performed in conjunction with tracheostomy. There were no major complications. Two patients had to undergo intraoperative tube replacement at 7 months and 18 months for chronic infection and tube damage, respectively. The only other complication was local irritation at the surgical site, which occurred in 2 (5.1%) patients. Our experience with percutaneous gastrostomy tube placement confirms that this is a procedure that can be safely performed by head and neck surgeons and should be part of otolaryngology–head and neck surgery training. The ability to provide comprehensive care of head and neck cancer patients as well as a means of supplemental feeding in conjunction with performing tracheostomy in neurologically impaired patients will no doubt improve the service that our specialty can provide. (Otolaryngol Head Neck Surg 1997;116:489-92.)

Percutaneous endoscopic gastrostomy by head and neck surgeons.

The endoscopic placement of percutaneous gastrostomy tubes has been an accepted technique for several years but has traditionally been performed by gastroenterologists and general surgeons. Fluoroscopically guided tube placement is now performed by radiologists. Head and neck surgeons have been slow to adopt the responsibility for placing percutaneous gastrostomy tubes despite the fact that most are proficient in both rigid and flexible esophagoscopy and trained in the Seldinger technique. We report on 41 percutaneous endoscopic gastrostomies performed in 39 patients by the Head and Neck Service at Stanford Medical Center between July 1, 1992, and August 30, 1995. There were 28 (71.8%) male and 11 (28.2%) female patients. Eleven (28.2%) procedures were performed in patients at the time of major head and neck resections. Another seven (17.9%) patients underwent percutaneous gastrostomy tube placement at the time of their initial staging panendoscopy before receiving chemotherapy and radiation. Fifteen (38.5%) procedures were performed for severe postsurgical dysphagia. Six (15.4%) patients had neurologic dysfunction, and this procedure was often performed in conjunction with tracheostomy. There were no major complications. Two patients had to undergo intraoperative tube replacement at 7 months and 18 months for chronic infection and tube damage, respectively. The only other complication was local irritation at the surgical site, which occurred in 2 (5.1%) patients. Our experience with percutaneous gastrostomy tube placement confirms that this is a procedure that can be safely performed by head and neck surgeons and should be part of otolaryngology-head and neck surgery training. The ability to provide comprehensive care of head and neck cancer patients as well as a means of supplemental feeding in conjunction with performing tracheostomy in neurologically impaired patients will no doubt improve the service that our specialty can provide.