Efficacy and Safety of In‐Office Transnasal Oesophagoscopy and Balloon Dilatation for Patients Presenting With High Dysphagia: A 6‐Year Retrospective Analysis

Abstract

ABSTRACTBackgroundThe primary objective of this study was to assess the efficacy and safety of in‐office transnasal oesophagoscopy (TNO) and balloon dilatation for patients presenting with symptoms of high dysphagia. The secondary objective was to conduct a subgroup analysis to better understand patient selection.MethodsRetrospective observational study from a single university hospital.ResultsTwo‐hundred four TNO and balloon dilatations were performed for 146 patients (median age 73 years; range 12–94 years). Indications included cricopharyngeal hypertrophy ± pouch (n = 70), hypopharyngeal/upper oesophageal web/stenosis (n = 18), head and neck cancer treatment‐related (n = 41), multi‐level obstruction (n = 13) and symptom‐based (n = 4). The mean EAT‐10 score improved from 21.2 (SD ± 8.92) pre‐dilatation to 12.6 (SD ± 10.7) post‐dilatation overall (median follow‐up 4.4 months; range 1.5 months–6.21 years). Cricopharyngeal hypertrophy and/or web without dysmotility cohort responded the best with the mean EAT‐10 score improvement from 20.4 (SD ± 8.21) to 4.4 (SD ± 6.71). Head and neck cancer patient group showed three types of responses: good response although effect transient requiring repeat dilatations; initial good response however stops responding over time and no response. The overall complication rate was 0.98% (n = 2/204; both failed in‐clinic attempts) with 0% perforation rate.ConclusionTNO and balloon dilatation is a safe and effective treatment modality for managing high dysphagia in patients with identifiable non‐malignant obstructive pathologies at and around the level of the upper oesophageal sphincter, including head and neck cancer treatment‐related patients, both short‐term and long‐term. Barium swallow is an excellent screening tool for assessing the swallow as a whole.