Mano-videoendoscopic assessment in the evaluation of the pharyngeal contraction and upper esophageal sphincter function in dysphagic patients.
OBJECTIVE
Mano-videoendoscopy (MVE) is a manometry technique with endoscopic confirmation of the pressure catheter. This study aimed to investigate the possibility of replacing a videofluorographic swallowing study (VFSS) with MVE for the precise evaluation of the pharyngeal contraction and the upper esophageal sphincter (UES) function.


METHODS
The data from 69 patients with dysphagia were retrospectively reviewed. All of the patients underwent both MVE and a VFSS for the evaluation of dysphagia. Manometry was performed with a transnasally inserted catheter (2.6-mm outer diameter and 4 pressure sensors) under endoscopic observation. The sensors were kept at the tongue base, upper pyriform sinus, apex of the pyriform sinus, and UES. We evaluated the pharyngeal contraction and UES function fluorographically and statistically compared the manometric parameters.


RESULTS
The fluorographic pharyngeal contraction was diagnosed as good in 28 patients and poor in 41 patients. The UES opening was diagnosed as good in 44 patients and poor in 25 patients. The highest pressure values at the tongue base (sensor 1), upper pyriform sinus (sensor 2), and apex of the pyriform sinus (sensor 3) were significantly larger in the good contraction group than in the poor contraction group. A stepwise logistic regression test revealed that the peak pressure of sensor 2 (upper pyriform sinus) was a robust predictor of fluorographic pharyngeal contraction, and the cut-off level for good fluorographic pharyngeal contraction was >81.5mmHg (specificity, 0.929; sensitivity, 0.870; area under the curve, 0.923). The nadir pressure, pressure drop, and pressure rise in the UES were significantly correlated with the fluorographic UES opening. A stepwise logistic regression test revealed that the pressure drop-the gap between the resting pressure and the nadir of the UES pressure-was a robust predictor of fluorographic UES opening, and the cut-off level to anticipate good fluorographic opening was ≥33.5mmHg (specificity, 0.853; sensitivity, 0.759).


CONCLUSIONS
MVE can supplement the information obtained regarding the pharyngeal contraction and UES function, and overcomes the drawbacks of a videoendoscopic swallowing study (VESS).
Department of Otolaryngology Head and Neck Surgery, Kyorin University, School of Medicine, Mitaka, Tokyo, Japan; Kyorin University Hospital Swallowing Center, Mitaka, Tokyo, Japan. Electronic address: takekaraho@ks.kyorin-u.ac.jp.
Takehiro
T
Karaho
Kyorin University Hospital Swallowing Center, Mitaka, Tokyo, Japan; Department of Oral and Maxillofacial Surgery, National Defense Medical College, Tokorozawa, Saitama, Japan.
Junko
J
Nakajima
Department of Otolaryngology Head and Neck Surgery, Kyorin University, School of Medicine, Mitaka, Tokyo, Japan; Kyorin University Hospital Swallowing Center, Mitaka, Tokyo, Japan.
Tetsuya
T
Satoh
Department of Otolaryngology Head and Neck Surgery, Kyorin University, School of Medicine, Mitaka, Tokyo, Japan; Kyorin University Hospital Swallowing Center, Mitaka, Tokyo, Japan.
Keisuke
K
Kawahara
Kyorin University Hospital Swallowing Center, Mitaka, Tokyo, Japan; Japan Welfare Education College, Shinjuku, Tokyo, Japan.
Takeshi
T
Nakayama
Department of Otolaryngology Head and Neck Surgery, Kyorin University, School of Medicine, Mitaka, Tokyo, Japan.
Naoyuki
N
Kohno
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003679:Deglutition / Q000502:physiology; D003680:Deglutition Disorders / Q000175:diagnosis / Q000503:physiopathology*; D049631:Esophageal Sphincter, Upper / Q000503:physiopathology*; D004945:Esophagoscopy; D005260:Female; D006801:Humans; D008297:Male; D008365:Manometry; D008875:Middle Aged; D009119:Muscle Contraction; D010609:Pharyngeal Muscles / Q000503:physiopathology*; D010614:Pharynx / Q000503:physiopathology*; D012189:Retrospective Studies; D014059:Tongue / Q000503:physiopathology; D014741:Video Recording
Dysphagia; Mano-videoendoscopic swallowing study; Manometry; Videofluorography