Outcomes of Self-Esophageal Dilation for Head and Neck Cancer Patients.

Abstract

Introduction Dysphagia is common following treatment for head and neck cancers, and self-esophageal dilation is a safe and effective treatment method. Prior studies on self-dilation have reported only qualitative results and included heterogeneous populations with dysphagia. The objective of this study is to quantitatively assess the safety and efficacy of a self-esophageal dilation program for patients with oropharyngeal squamous cell cancer with treatment-induced dysphagia. Materials and Methods This is a retrospective review of patients with oropharyngeal squamous cell cancer treated at the University of Southern California from 2009 to 2013 with dysphagia following radiation treatment that persisted after swallow therapy. The treatment program consisted of swallow therapy in conjunction with weekly self-esophageal dilation at home with increasing size bougie dilators. Oral intake was monitored using the Functional Oral Intake Scale ( Crary, Mann, & Groher, 2005 ), Modified Barium Swallow Impairment Profile Pharyngoesophageal opening score, and Penetration-Aspiration Scale ( Rosenbek, Robbins, Roecker, Coyle, & Wood, 1996 ) pre- and posttreatment. Results Thirty-three patients met study criteria and completed the program. Twenty-five patients required nutrition via a gastrostomy tube prior to starting therapy, and 84% (21/25) of these patients were able to have the feeding tube removed. Median Functional Oral Intake Scale ( Crary et al., 2005 ) predilation was 1 (range: 1-5), and postdilation was 6 (range: 3-6, p < .05). In addition, there was improvement of the Modified Barium Swallow Impairment Profile Pharyngoesophageal opening score from 2 to 1 after treatment ( p < .05). No complications were encountered. Discussion Home self-dilation with concurrent swallowing therapy is a safe and feasible procedure to be used in motivated patients with dysphagia following head and neck cancer treatment.