Original research| Volume 100, ISSUE 6, P1076-1084, June 2019

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Determining the Efficacy of the Chin-Down Maneuver Following Esophagectomy With Fiberoptic Endoscopic Evaluation of Swallowing

Published:November 01, 2018DOI:



      To clarify the reliability of fiberoptic endoscopic evaluation of swallowing (FEES) compared to videofluoroscopic swallowing studies (VFSSs). Second, we explored the effect of the chin-down maneuver in the presence or absence of vocal fold paralysis (VFP) using FEES in patients with 3-field lymphadenectomy (3FL) postesophagectomy.


      Retrospective data collection from FEES and VFSS.


      Dysphagic clinics in the ear, nose, and throat department.


      Patients (N=15) underwent esophagectomy with 3FL at the Department of Gastroenterologic Surgery, during a period of 12 months.


      The patients underwent FEES and VFSS with neutral and chin-down maneuvers 2 weeks postoperatively. Two raters of speech pathology blindly scored aspiration, penetration, delayed initiation, and pharyngeal clearance in the pyriform sinus and vallecula, respectively, from recorded movie clips of both examinations, using the penetration aspiration scale (PAS) and modified Hyodo FEES rating scale.

      Main Outcome Measures

      The intrarater and interrater correlation coefficients of each parameter examined with FEES. Statistical comparison of each parameter between FEES and VFSS and of each parameter evaluated using FEES between 2 maneuvers with or without VFP.


      The intrarater and interrater correlation coefficients of the PAS and pyriform sinus examined with FEES were both statistically consistent between the 2 raters. The PAS and pyriform sinus evaluated using FEES were significantly correlated with those evaluated in a VFSS (P<.05). The 2 parameters evaluated using FEES were significantly (P<.05) improved with the chin-down maneuver compared to the neutral maneuver, especially in VFP patients.


      FEES performed postesophagectomy with 3FL for evaluation of aspiration is as reliable statistically as VFSSs. The chin-down maneuver is especially useful for reducing the PAS score and pyriform sinus in VFP patients.


      List of abbreviations:

      3FL (3-field lymphadenectomy), FEES (fiberoptic endoscopic evaluation of swallowing), PAS (penetration aspiration scale), UES (upper esophageal sphincter), VFP (vocal fold paralysis), VFSS (videofluoroscopic swallowing study)
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