Results of comprehensive dysphagia evaluation and delayed oral intake following esophagectomy

Background: Dysphagia with or without aspiration are potential problems for patients following esophagectomy. We have adopted a strategy of routine post-discharge modified barium swallow study (MBSS) after esophagectomy in concert with our Speech and Language Pathology (SLP) Department to identify patients with dysphagia or aspiration persisting beyond the immediate post-operative period. We performed a cohort study of these patients at our institution. Methods: Patients who underwent esophagectomy and postoperative MBSS from 2011–2016 were identified from an institutional database. Patients were typically discharged home on tube feedings, taking nothing by mouth. MBSS was usually performed in a delayed fashion unless there was clinical suspicion of leak. Logistic regression analyses were performed to assess factors associated with perioperative outcomes. Results: A total of 50 consecutive patients were identified. Median age was 66 years (range, 36–85). The Ivor Lewis technique was performed in 45 patients (90%) and 43 resections were completed minimally invasively. Anastomotic leak rate was 6% and aspiration pneumonia rate was 14%. MBSS was performed median 17 days after resection; 8 patients demonstrated radiographic evidence of dysfunctional oropharyngeal swallow mechanism with or without aspiration. Weekly swallow treatment by our SLP department improved aspiration/dysphagia at median 5.5 weeks. On multivariate analyses, only age ≥70 was associated with aspiration and/or dysphagia on MBSS, and only aspiration was associated with pneumonia. Conclusions: Older age is independently associated with dysphagia with or without radiographic aspiration on MBSS. Aspiration pneumonia was associated with frank aspiration events or findings of dysphagia/aspiration on MBSS. With a standardized interdisciplinary approach to post-operative swallow dysfunction, swallow therapy is effective to safely restart oral intake after esophagectomy.