Manometric Pattern Predicts the Outcome of Transoral Swallowing Surgery for Pharyngeal Dysphagia.

Abstract

Transoral swallowing surgery (TOSS) based on endoscopic cricopharyngeal myotomy (ECPM) in combination with fat injection laryngoplasty (FIL) and/or pharyngeal flap surgery (PFS) is a useful treatment option for pharyngeal dysphagia. However, no quantitative evaluation method has been established to predict surgical outcomes. This study aimed to clarify swallowing pressure conditions that affect the outcome of TOSS for pharyngeal dysphagia. Twenty-two patients with pharyngeal dysphagia who had undergone high-resolution manometry before and after TOSS were enrolled. TOSS procedures included ECPM alone in 8 patients, ECPM+FIL in 5, and ECPM+FIL + PFS in 9. Good surgical outcome (GS) was defined as achieving a functional oral intake scale (FOIS) level of ≥ 4 on a 7-point scale or an improvement in FOIS level by ≥ 2 for those with a preoperative level of 4 or 5. Manometric data in the nasopharyngeal, oropharyngeal, hypopharyngeal, oro-hypopharyngeal, and upper esophageal sphincter (UES) zones were compared between patients with and without GS (GS and non-GS groups, respectively) and by procedure. Mean pre- to postoperative FOIS levels in the GS group (n = 14) and non-GS group (n = 8) ranged from 2.6 to 5.7 and 3.3 to 3.8, respectively. There were significant differences between the GS and non-GS groups in distal contractile integrals (DCIs) of the oropharynx and oro-hypopharynx. All postoperative pharyngeal pressures and DCIs of the pharynx were increased, whereas those related to the UES were decreased. Our manometric analysis revealed that preoperative oropharyngeal pressure is a factor influencing the outcome of TOSS, regardless of UES pressure. TOSS can produce efficient postoperative pressure changes.