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Eur J Pediatr Surg
DOI: 10.1055/a-2181-2293
Original Article

Dynamic Imaging Grade of Swallowing Toxicity in Children with Esophageal Atresia

Numan Demir
1   Faculty of Physical Medicine and Rehabilitation, Hacettepe Universitesi, Ankara, Turkey
,
Begüm Pişiren
2   Department of Pediatric Surgery, Hacettepe University Faculty of Medicine, Ankara, Turkey
,
Selen Serel Arslan
1   Faculty of Physical Medicine and Rehabilitation, Hacettepe Universitesi, Ankara, Turkey
,
Ozlem Boybeyı-Turer 
2   Department of Pediatric Surgery, Hacettepe University Faculty of Medicine, Ankara, Turkey
,
Tutku Soyer 
2   Department of Pediatric Surgery, Hacettepe University Faculty of Medicine, Ankara, Turkey
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Abstract

Introduction The Dynamic Imaging Grade of Swallowing Toxicity (DIGEST) scale was developed to evaluate the safety, efficiency, and overall pharyngeal swallowing performance in patients with dysphagia (DIGESTs, DIGESTe, and DIGESTt, respectively). Although various types of swallowing dysfunction are encountered in children with esophageal atresia (EA), oropharyngeal dysphagia poses risk for aspiration. Therefore, a retrospective study was performed to evaluate the safety and efficacy of swallowing by using DIGEST score in children with EA.

Patients and Methods Thirty-nine EA patients were included. The demographic features, respiratory problems, results, and outcomes of surgical treatment were evaluated from medical records. The videofluoroscopic swallowing evaluation investigated for both airway protection and bolus residuals at the level of vallecula, posterior pharyngeal wall, and pyriform sinus at liquid and pudding consistencies. The penetration and aspiration scale (PAS) was used to define penetration and aspiration severity, and DIGEST was used to evaluate DIGESTs, DIGESTe, and DIGESTt.

Results The median age of the patients were 13 months (7–39 months), and male-to-female ratio was 25:14. Sixty-seven percent of patients were type-C EA and 61% of them has associated anomalies; 38% of patients had aspiration (PAS = 6–8) in liquids and 10% in pudding consistency. Life-threatening/profound swallowing dysfunction in DIGESTe (DIGEST = 4) was seen in 13% (n = 5) of patients; 40% of EA patients showed severe problems in DIGESTt.

Conclusion DIGEST is a valid and reliable tool to define the efficacy and safety of swallowing in children with EA.

Keywords

esophageal atresia - tracheoesophageal fistula - swallowing - dysphagia - children


Publication History

Received: 05 July 2023

Accepted: 21 September 2023

Accepted Manuscript online:
25 September 2023

Article published online:
28 November 2023

© 2023. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

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