The upper esophageal sphincter is not round

A pilot study evaluating a novel, physiology-based approach to upper esophageal sphincter dilation

Peter C Belafsky, Emily K. Plowman, Omid Mehdizadeh, Daniel Cates, Amanda Domer, Kaicheng Yen

Research output: Contribution to journalArticle

10 Citations (Scopus)

Abstract

Objectives: Recent basic science investigations have suggested that the upper esophageal sphincter (UES), in cross section, is not round, but that it more closely approximates a kidney shape. Dilation with simultaneous use of two cylindrical dilators provides a novel, physiology-based approach to UES distention. We evaluated the initial safety and efficacy of UES dilation with simultaneous use of two controlled radial expansion balloon dilators. Methods: Using a computerized database, we reviewed the charts of all persons who underwent UES dilation with simultaneous use of two radial expansion balloon dilators between December 1, 2011, and March 15, 2012. Information regarding patient demographics, indications, technique, and complications was abstracted. Self-reported swallowing impairment was assessed with the validated 10-item Eating Assessment Tool (EAT-10). Results: Ten individuals underwent simultaneous dilation with two dilators. Their mean age was 65 years (SD, 14 years), and 7 (70%) of them were male. The indications for dilation were radiation-induced UES stenosis (50%), cricopharyngeus muscle dysfunction (30%), upper esophageal web (10%), and anastomotic stricture (10%). After the double-balloon dilation, no complications were reported. The mean EAT-10 score improved significantly, from 34.3 (SD, 13.5) to 16.7 (SD, 8.4), after the simultaneous dilation (p = 0.003). Conclusions: Pilot data suggest that simultaneous dilation of the UES with two controlled radial expansion balloon dilators is feasible, safe, and effective. Future investigation is necessary to confirm the safety of this technique in a larger cohort and to use objective measures of efficacy to compare the technique to conventional dilation with a single dilator.

Original languageEnglish (US)
Pages (from-to)217-221
Number of pages5
JournalAnnals of Otology, Rhinology and Laryngology
Volume122
Issue number4
StatePublished - Apr 2013

Fingerprint

Upper Esophageal Sphincter
Dilatation
Pharyngeal Muscles
Safety
Esophageal Stenosis
Deglutition
Pathologic Constriction
Eating
Demography
Databases
Radiation

Keywords

  • Balloon
  • Bougie
  • Controlled radial expansion balloon
  • Dilation
  • Dysphagia
  • Esophagus
  • Stricture
  • UES
  • Upper esophageal sphincter
  • Web

ASJC Scopus subject areas

  • Otorhinolaryngology

Cite this

The upper esophageal sphincter is not round : A pilot study evaluating a novel, physiology-based approach to upper esophageal sphincter dilation. / Belafsky, Peter C; Plowman, Emily K.; Mehdizadeh, Omid; Cates, Daniel; Domer, Amanda; Yen, Kaicheng.

In: Annals of Otology, Rhinology and Laryngology, Vol. 122, No. 4, 04.2013, p. 217-221.

Research output: Contribution to journalArticle

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abstract = "Objectives: Recent basic science investigations have suggested that the upper esophageal sphincter (UES), in cross section, is not round, but that it more closely approximates a kidney shape. Dilation with simultaneous use of two cylindrical dilators provides a novel, physiology-based approach to UES distention. We evaluated the initial safety and efficacy of UES dilation with simultaneous use of two controlled radial expansion balloon dilators. Methods: Using a computerized database, we reviewed the charts of all persons who underwent UES dilation with simultaneous use of two radial expansion balloon dilators between December 1, 2011, and March 15, 2012. Information regarding patient demographics, indications, technique, and complications was abstracted. Self-reported swallowing impairment was assessed with the validated 10-item Eating Assessment Tool (EAT-10). Results: Ten individuals underwent simultaneous dilation with two dilators. Their mean age was 65 years (SD, 14 years), and 7 (70{\%}) of them were male. The indications for dilation were radiation-induced UES stenosis (50{\%}), cricopharyngeus muscle dysfunction (30{\%}), upper esophageal web (10{\%}), and anastomotic stricture (10{\%}). After the double-balloon dilation, no complications were reported. The mean EAT-10 score improved significantly, from 34.3 (SD, 13.5) to 16.7 (SD, 8.4), after the simultaneous dilation (p = 0.003). Conclusions: Pilot data suggest that simultaneous dilation of the UES with two controlled radial expansion balloon dilators is feasible, safe, and effective. Future investigation is necessary to confirm the safety of this technique in a larger cohort and to use objective measures of efficacy to compare the technique to conventional dilation with a single dilator.",
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