CLINICAL IMAGE
Structural cause of dysphagia detected during videofluoroscopic swallow study Ezekiel Wong Toh Yoon1
& Syu Kabuto2
1
Department of Internal Medicine (Gastroenterology), Hiroshima Kyoritsu Hospital, Hiroshima, Japan Department of Palliative Care, Hiroshima Kyoritsu Hospital, Hiroshima, Japan
2
Correspondence Ezekiel Wong Toh Yoon, Department of Internal Medicine, Hiroshima Kyoritsu Hospital, 2-20-20 Nakasu Asaminami-ku, Hiroshima, Japan. Tel: 8182-879-1111; Fax: 8182-879-6964; E-mail: [email protected]
Key Clinical Message
Funding Information No sources of funding were declared for this study.
Keywords
Dysphagia can be caused by many different underlying conditions. The assessment and management of dysphagia depend on each individual patient, often requiring a multidisciplinary approach. Structural cause of dysphagia can be dealt with using endoscopic interventions before the patient’s general status deteriorates.
Aspiration pneumonia, dysphagia, esophageal cancer.
Received: 2 March 2017; Revised: 29 May 2017; Accepted: 30 May 2017 Clinical Case Reports 2017; 5(8): 1420–1421 doi: 10.1002/ccr3.1057
A 72-year-old man was referred to receive percutaneous endoscopic gastrostomy (PEG). About 2 months ago, he was treated in a tertiary hospital for aspiration pneumonia but dysphagia persisted and there was difficulty in replacing his nasogastric tube. During routine videofluoroscopic swallow study conducted by our dysphagia team, severe aspiration was observed as the ingested material consistently regurgitated from the upper esophagus. A chest radiograph was taken immediately after the study (Fig. 1).
What is Your Diagnosis? Upper gastrointestinal endoscopy was recommended and confirmed severe stenosis of the mid-thoracic esophagus from esophageal cancer (Fig. 2). Esophageal stenting alleviated some of his symptoms (Fig. 3), but due to his poor general status, curative surgery was deemed not suitable and he was transferred to palliative care. Although PEG followed by swallowing therapy can be effective in some patients with dysphagia [1], the underlying cause for each patient needs individual assessment and management [2]. A multidisciplinary approach may be useful to rule out 1420
Figure 1. Anterior chest radiograph taken after videofluoroscopic swallowing study (red arrow head pointing to the pooling of contrast material above the mid-thoracic esophagus).
ª 2017 The Authors. Clinical Case Reports published by John Wiley & Sons Ltd. This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.
Toh Yoon E.W. & S. Kabuto
Figure 2. Endoscopic image revealing severe stenosis of the midthoracic esophagus due to esophageal cancer.
structural causes, and noninvasive interventions, such as in this case, may prevent the deterioration of general status if performed earlier.
Authorship EWTY: prepared the manuscript. SK: had an advisory role in the management of the patient.
Conflict of Interest
Structural cause of dysphagia
Figure 3. Lateral chest radiograph after self-expandable metallic stent insertion (red arrow head pointing to the area of stenosis).
References 1. Toh Yoon, E. W., J. Hirao, and N. Minoda. 2016. Outcome of rehabilitation and swallowing therapy after percutaneous endoscopic gastrostomy in dysphagia patients. Dysphagia 31:730–736. 2. White, G. N., F. O’Rourke, B. S. Ong, D. J. Cordato, and D. K. Chan 2008. Dysphagia: causes, assessment, treatment, and management. Geriatrics 63:15–20.
None declared.
ª 2017 The Authors. Clinical Case Reports published by John Wiley & Sons Ltd.
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Structural cause of dysphagia detected during videofluoroscopic swallow study Ezekiel Wong Toh Yoon1
& Syu Kabuto2
1
Department of Internal Medicine (Gastroenterology), Hiroshima Kyoritsu Hospital, Hiroshima, Japan Department of Palliative Care, Hiroshima Kyoritsu Hospital, Hiroshima, Japan
2
Correspondence Ezekiel Wong Toh Yoon, Department of Internal Medicine, Hiroshima Kyoritsu Hospital, 2-20-20 Nakasu Asaminami-ku, Hiroshima, Japan. Tel: 8182-879-1111; Fax: 8182-879-6964; E-mail: [email protected]
Key Clinical Message
Funding Information No sources of funding were declared for this study.
Keywords
Dysphagia can be caused by many different underlying conditions. The assessment and management of dysphagia depend on each individual patient, often requiring a multidisciplinary approach. Structural cause of dysphagia can be dealt with using endoscopic interventions before the patient’s general status deteriorates.
Aspiration pneumonia, dysphagia, esophageal cancer.
Received: 2 March 2017; Revised: 29 May 2017; Accepted: 30 May 2017 Clinical Case Reports 2017; 5(8): 1420–1421 doi: 10.1002/ccr3.1057
A 72-year-old man was referred to receive percutaneous endoscopic gastrostomy (PEG). About 2 months ago, he was treated in a tertiary hospital for aspiration pneumonia but dysphagia persisted and there was difficulty in replacing his nasogastric tube. During routine videofluoroscopic swallow study conducted by our dysphagia team, severe aspiration was observed as the ingested material consistently regurgitated from the upper esophagus. A chest radiograph was taken immediately after the study (Fig. 1).
What is Your Diagnosis? Upper gastrointestinal endoscopy was recommended and confirmed severe stenosis of the mid-thoracic esophagus from esophageal cancer (Fig. 2). Esophageal stenting alleviated some of his symptoms (Fig. 3), but due to his poor general status, curative surgery was deemed not suitable and he was transferred to palliative care. Although PEG followed by swallowing therapy can be effective in some patients with dysphagia [1], the underlying cause for each patient needs individual assessment and management [2]. A multidisciplinary approach may be useful to rule out 1420
Figure 1. Anterior chest radiograph taken after videofluoroscopic swallowing study (red arrow head pointing to the pooling of contrast material above the mid-thoracic esophagus).
ª 2017 The Authors. Clinical Case Reports published by John Wiley & Sons Ltd. This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.
Toh Yoon E.W. & S. Kabuto
Figure 2. Endoscopic image revealing severe stenosis of the midthoracic esophagus due to esophageal cancer.
structural causes, and noninvasive interventions, such as in this case, may prevent the deterioration of general status if performed earlier.
Authorship EWTY: prepared the manuscript. SK: had an advisory role in the management of the patient.
Conflict of Interest
Structural cause of dysphagia
Figure 3. Lateral chest radiograph after self-expandable metallic stent insertion (red arrow head pointing to the area of stenosis).
References 1. Toh Yoon, E. W., J. Hirao, and N. Minoda. 2016. Outcome of rehabilitation and swallowing therapy after percutaneous endoscopic gastrostomy in dysphagia patients. Dysphagia 31:730–736. 2. White, G. N., F. O’Rourke, B. S. Ong, D. J. Cordato, and D. K. Chan 2008. Dysphagia: causes, assessment, treatment, and management. Geriatrics 63:15–20.
None declared.
ª 2017 The Authors. Clinical Case Reports published by John Wiley & Sons Ltd.
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