Clinical utility of a functional lumen imaging probe in management of dysphagia following head and neck cancer therapies

Endoscopy. 2017 Sep;49(9):848-854. doi: 10.1055/s-0043-110670. Epub 2017 May 31.


Background and aims Chemoradiotherapy for head and neck cancer (HNC) with/without laryngectomy commonly causes dysphagia. Pharyngoesophageal junction (PEJ) stricturing is an important contributor. We aimed to validate a functional lumen imaging probe (the EndoFLIP system) as a tool for quantitating pretreatment PEJ distensibility and treatment-related changes in HNC survivors with dysphagia and to evaluate the diagnostic accuracy of EndoFLIP-derived distensibility in detecting PEJ strictures. Methods We studied 34 consecutive HNC survivors with long-term (> 12 months) dysphagia who underwent endoscopic dilation for suspected strictures. Twenty non-dysphagic patients undergoing routine endoscopy served as controls. PEJ distensibility was measured at endoscopy with the EndoFLIP system pre- and post-dilation. PEJ stricture was defined as the presence of a mucosal tear post-dilation. Results PEJ stricture was confirmed in 22/34 HNC patients (65 %). During distension up to 60 mmHg, the mean EndoFLIP-derived narrowest cross-sectional area (nCSA) in HNC patients with strictures, without strictures, and in controls were 58 mm2 (95 % confidence interval [CI] 22 to 118), 195 mm2 (95 %CI 129 to 334), and 227 mm2 (95 %CI 168 to 316), respectively. A cutoff of 114 mm2 for the nCSA at the PEJ had perfect diagnostic accuracy in detecting strictures (area under the receiver operating characteristic curve = 1). In patients with strictures, a single session of dilation increased the nCSA by 29 mm2 (95 %CI 20 to 37; P < 0.001). In patients with no strictures, dilation caused no change in the nCSA (mean difference 13 mm2 [95 %CI -4 to 30]; P = 0.13). Conclusions EndoFLIP is a highly accurate technique for the detection of PEJ strictures. EndoFLIP may complement conventional diagnostic tools in the detection of pharyngeal outflow obstruction.

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Aged, 80 and over
  • Area Under Curve
  • Chemoradiotherapy / adverse effects
  • Constriction, Pathologic / diagnosis
  • Constriction, Pathologic / etiology
  • Constriction, Pathologic / therapy
  • Deglutition Disorders / etiology*
  • Deglutition Disorders / therapy
  • Dilatation
  • Esophageal Stenosis / diagnosis*
  • Esophageal Stenosis / etiology
  • Esophageal Stenosis / therapy
  • Female
  • Head and Neck Neoplasms / therapy*
  • Humans
  • Laryngectomy / adverse effects
  • Male
  • Middle Aged
  • Pharynx / pathology*
  • Plethysmography, Impedance
  • ROC Curve
  • Radiotherapy, Adjuvant / adverse effects
  • Young Adult