Evaluating Dysphagia: Maximize exam and swallow studies for diagnostic success

Because TNE is performed without sedation, it is less expensive and safer than conventional endoscopy (Surg Innov. 2006;13(1):31-39). Its diagnostic accuracy is equal to conventional endoscopy and, in randomized trials comparing the two techniques, patients prefer TNE over endoscopy (Endoscopy 2005;37(6):559-565). TNE can be especially useful, Dr. Postma said, in diagnosing Barrett’s esophagitis and benign and malignant lesions of the esophagus, as well as in follow-up with head and neck cancer patients (Otol Head Neck Surg. 2008;138(4):411-414). Another advantage: Esophageal strictures can be safely treated using balloon dilation in the office.

Selecting Technique

Clinicians must select diagnostic techniques on a “case by case basis,” Dr. Leonard said. For example, if a patient complains of a solid food dysphagia and an esophageal problem is suspected, FEES is not the preferred modality. However, Dr. Belafsky noted, none of these methods is exclusive of the others. “They’re complementary, and in patients with very severe symptoms, a combination of all types might be used at various points in the diagnostic continuum,” he said.

Dr. Leonard also urges clinicians to devote time to a thorough history and to annotate that on patients’ charts. “Sometimes,” she said, “we’re seeing patients for the first time when they show up in the fluoroscopy suite. If you want to stack the deck in the patient’s favor, you need to know as much of the relevant history as you possibly can. A pre-fluoro history and clinical exam is essential.” ENTtoday

Gretchen Henkel is a medical writer based in California.

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