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II.
BRONCHOESOPHAGOLOGY
A. Esophageal Dysphagia
Kocdor P, Siegel ER, Tulunay-Ugur OE. Cricopharyngeal dysfunction: a systematic
review comparing outcomes of dilatation, botulinum toxin injection, and myotomy.
Laryngoscope
. 2016; 126(1):135-141. EBM level 2a............................................106-112
Summary:
This systematic review of cohort studies evaluated the outcomes between different
interventions for cricopharyngeal (CP) dysfunction, including CP dilation, botulinum toxin
injections, and myotomy. The authors found that there was a significant increase in the odds of
success and decreased complication rates with endoscopic myotomy versus open myotomy. They
also found that myotomy was more effective than botulinum toxin injections.
Miles A, McMillan J, Ward K, Allen J. Esophageal visualization as an adjunct to the
videofluoroscopic study of swallowing.
Otolaryngol Head Neck Surg
. 2015;
152(3):488-493. EBM level 4..................................................................................113-118
Summary:
Miles et al hypothesize that esophageal disorders are the cause for dysphagia in many
patients and propose that studying the esophagus as part of videofluoroscopic study of swallowing
will yield greater diagnosis of abnormalities. Their findings suggest that esophageal disease is
common and sometimes is the only abnormality in patients with cervical dysphagia. Furthermore,
esophageal abnormalities frequently coexist with oral and pharyngeal disorders.
Moawad FJ, Veerappan GR, Dias JA, et al. Randomized controlled trial comparing
aerosolized swallowed fluticasone to esomeprazole for esophageal eosinophilia.
Am J
Gastroenterol
. 2013; 108(3):366-372. EBM level 1b............................................119-125
Summary:
This single-blinded, randomized controlled trial compared the efficacy of swallowed
aerosolized steroids (fluticasone) to a proton pump inhibitor (omeprazole) for the treatment of
eosinophilic esophagitis (EOE)–an important cause of esophageal dysphagia. Gastroesophageal
reflux disease (GERD) patients were stratified equally into each arm. GERD patients with
eosinophilia had improvement in their dysphagia symptoms and eosinophilia in biopsy specimens
with PPI treatment alone. Current guidelines recommend failed trial of PPI prior to formal
diagnosis of EOE due to this “newer” entity of PPI-responsive EOE.
Peng KA, Feinstein AJ, Salinas JB, Chhetri DK. Utility of the transnasal esophagoscope
in the management of chemoradiation-induced esophageal stenosis.
Ann Otol Rhinol
Laryngol
. 2015; 124(3):221-226. EBM level 4......................................................126-131
Summary:
This article establishes the applications and safety of the transnasal esophagoscope
(TNE) for chemoradiation-induced pharyngoesophageal swallowing dysfunction. Through use of
a modified dysphagia score, the Functional Outcome Swallowing Scale (FOSS), the authors also
suggest efficacy of TNE-based procedures in the population.
B. Esophagopharyngeal Reflux
Jetté ME, Gaumnitz EA, Birchall MA, et al. Correlation between reflux and
multichannel intraluminal impedance pH monitoring in untreated volunteers.
Laryngoscope
. 2014; 124(10):2345-2351. EBM level 1b......................................132-138
Summary:
This study shows that the Reflux Finding Score (RFS) is not specific to detect
laryngopharyngeal reflux in healthy volunteers, suggesting that other things can cause laryngeal
inflammation.