Endoscopy 2018; 50(04): S48
DOI: 10.1055/s-0038-1637170
ESGE Days 2018 oral presentations
20.04.2018 – Motility disorders
Georg Thieme Verlag KG Stuttgart · New York

FUNCTIONAL ENDOSCOPY IN NEUROGENIC DYSPHAGIA

J Rückert
1   Josephs-Hospital Warendorf,Academic Teaching Hospital, University of Muenster, Department of Medicine I, Warendorf, Germany
2   University of Muenster, Department of Medicine B, Muenster, Germany
,
P Lenz
2   University of Muenster, Department of Medicine B, Muenster, Germany
3   University of Muenster, Institute of Palliative Care, Muenster, Germany
,
H Heinzow
2   University of Muenster, Department of Medicine B, Muenster, Germany
,
F Lenze
2   University of Muenster, Department of Medicine B, Muenster, Germany
,
I Suttrup
4   University of Muenster, Department of Neurology, Muenster, Germany
,
R Dziewas
4   University of Muenster, Department of Neurology, Muenster, Germany
,
T Warnecke
4   University of Muenster, Department of Neurology, Muenster, Germany
,
J Wessling
5   Clemens Hospital Muenster, Department of Radiology, Muenster, Germany
,
I Herrmann
6   Reflux Center Duesseldorf, Duesseldorf, Germany
,
D Domagk
1   Josephs-Hospital Warendorf,Academic Teaching Hospital, University of Muenster, Department of Medicine I, Warendorf, Germany
2   University of Muenster, Department of Medicine B, Muenster, Germany
› Author Affiliations
Further Information

Publication History

Publication Date:
27 March 2018 (online)

Also available at
 

Aims:

Due to demographic transition, neurogenic dysphagia has become an increasingly recognized problem. Patients suffering from dysphagia often get caught between different clinical disciplines. This dilemma might be due to a lack of pathophysiological knowledge and an inability to directly visualize the esophageal phase of deglutition. In this study, we tried to implement a defined examination protocol for functional endoscopy in patients with neurogenic dysphagia [NCT01995929].

Methods:

This prospective observational study was performed in a multidisciplinary setting: 31 consecutive patients with suspected neurogenic dysphagia were evaluated by transnasal access applying an ultrathin video endoscope. We applied a modified approach including standardized endoscopic positions to compare our findings with fiberoptic endoscopic evaluation of swallowing (FEES) and high-resolution manometry. For functional endoscopy, unsedated patients were examined while ingesting food of different consistencies. Primary outcome measure was feasibility of functional endoscopy. Secondary outcome measures were adverse events, tolerability and pathologic endoscopic findings.

Results:

Functional endoscopy was successfully performed in all patients. No adverse events were recorded. Endoscopic findings correlated well with the clinical signs of the patients and the other diagnostic modalities. A variety of disorders were documented by functional endoscopy: Incomplete or delayed closure of the upper esophageal sphincter (in retroflex view), clearance disturbance of tubular esophagus, esophageal hyperperistalsis and hypomotility.

Conclusions:

By interdisciplinary cooperation with additional assessment of the esophageal phase of deglutition using the innovative method of functional endoscopy, the diagnostic of neurogenic disorders including dysphagia may be tremendously improved leading to a better clinical understanding of complex dysfunctional patterns. To our best knowledge, this is the first study to show that a retroflex view of the ultrathin video endoscope within the esophagus may be safely performed. This comprehensive approach should be helpful to develop a new scoring system to grade severity level of dysphagia focused on the esophageal phase of deglutition