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Appropriateness Criteria

Reference Study Type Patients/Events Study Objective(Purpose of Study) Study Results Study Quality
1. Carucci LR, Turner MA. Dysphagia revisited: common and unusual causes. [Review]. Radiographics. 35(1):105-22, 2015 Jan-Feb. Review/Other-Dx N/A To discuss dysphagia in terms of techniques for imaging evaluation, common and uncommon causes (eg, swallowing dysfunction, motility abnormalities, diverticular disease,webs and rings, extrinsic processes, vascular phenomena,infection, strictures, neoplasms, foreignbodies, and postoperative changes), and relevant imaging findings. No results stated in abstract. 4
2. Matsuo K, Palmer JB. Anatomy and physiology of feeding and swallowing: normal and abnormal. Phys Med Rehabil Clin N Am. 2008;19(4):691-707, vii. Review/Other-Dx N/A No abstract available. No abstract available. 4
3. Kuo P, Holloway RH, Nguyen NQ. Current and future techniques in the evaluation of dysphagia. J Gastroenterol Hepatol. 2012; 27(5):873-881. Review/Other-Dx N/A To review the current clinical and laboratory assessments of dysphagia and the emerging techniques that have been developed recently that allows better understanding of esophageal motor function. No results stated in abstract. 4
4. Wilkins T, Gillies RA, Thomas AM, Wagner PJ. The prevalence of dysphagia in primary care patients: a HamesNet Research Network study. J Am Board Fam Med. 2007; 20(2):144-150. Review/Other-Dx 947 patients To determine the prevalence of dysphagia in primary care patients. Of the 947 study participants, 214 (22.6%) reported dysphagia occurring several times per month or more frequently. Those reporting dysphagia were more likely to be women (80.8% women vs 19.2% men, P=.002) and older (mean age of 48.1 in patients with dysphagia vs mean age of 45.7 in patients without dysphagia, P=.001). 64% of patients with dysphagia indicated that they were concerned about their symptoms, but 46.3% had not spoken with their doctor about their symptoms. Logistic regression analyses showed that increased frequency (OR = 2.15, 95% CI, 1.41-3.30), duration (OR = 1.91, CI 1.24-2.94), and concern (OR = 2.64, CI 1.36-5.12) of swallowing problems as well as increased problems eating out (OR = 1.72, CI 1.19-2.49) were associated with increased odds of having talked to a physician. 4
5. Cook IJ. Oropharyngeal dysphagia. Gastroenterol Clin North Am. 2009; 38(3):411-431. Review/Other-Dx N/A To review oropharyngeal dysphagia. No results stated in abstract. 4
6. Wilcox CM, Alexander LN, Clark WS. Localization of an obstructing esophageal lesion. Is the patient accurate? Dig Dis Sci. 1995; 40(10):2192-2196. Observational-Dx 139 patients To determine if patient’s sensation of dysphagia can accurately localize obstructing esophageal lesions. Patients more accurate in localizing proximal rather than distal lesions, as distal lesions often cause referred dysphagia. 2
7. Sanchez TR, Holz GS, Corwin MT, Wood RJ, Wootton-Gorges SL. Follow-up barium study after a negative water-soluble contrast examination for suspected esophageal leak: is it necessary?. Emergency Radiology. 22(5):539-42, 2015 Oct.EMERG. RADIOL.. 22(5):539-42, 2015 Oct. Observational-Dx 49 patients To determine the value of follow-up barium esophogram in diagnosing esophageal injury or leak if the initial water-soluble contrast examination of the esophagus is normal. Forty-six studies were negative on both water-soluble contrast and barium studies. Two studies were both positive on the initial water-soluble contrast and subsequent barium studies. A single study showed the esophageal leak only in the water-soluble study, with the follow-up barium exam being normal. 4
8. American College of Radiology. ACR Practice Parameter for the Performance of Esophagrams and Upper Gastrointestinal Examinations in Adults. Available at: https://gravitas.acr.org/PPTS/GetDocumentView?docId=46+&releaseId=2 Review/Other-Dx N/A Guidance document to promote the safe and effective use of diagnostic and therapeutic radiology by describing specific training, skills and techniques. No abstract available. 4
9. Jaffer NM, Ng E, Au FW, Steele CM. Fluoroscopic evaluation of oropharyngeal dysphagia: anatomic, technical, and common etiologic factors. [Review]. AJR Am J Roentgenol. 204(1):49-58, 2015 Jan. Review/Other-Dx N/A To review the anatomy of the upper gastrointestinal tract; review techniques and contrast agents used in the fluoroscopic examination of the oropharynx and hypopharynx; provide a pictorial review of some important causes of oropharyngeal dysphagia; and link these causes to key findings in the clinical history to assist in establishing a clinical diagnosis. No results stated in abstract. 4
10. Logemann JA. Role of the modified barium swallow in management of patients with dysphagia. Otolaryngol Head Neck Surg. 1997; 116(3):335-338. Review/Other-Dx N/A Reviews role and technique of modified barium swallow in patients with oropharyngeal dysphagia. Modified barium swallow can be effective tool in rehabilitation of these patients. 4
11. Chen YM, Ott DJ, Gelfand DW, Munitz HA. Multiphasic examination of the esophagogastric region for strictures, rings, and hiatal hernia: evaluation of the individual techniques. Gastrointest Radiol. 1985; 10(4):311-316. Observational-Dx 159 patients To compare radiographic and endoscopic sensitivities in patients with lower esophageal rings. 95% of lower esophageal rings detected by barium esophagography vs 76% by endoscopy. Radiographic examination more accurate. 3
12. Miles A, McMillan J, Ward K, Allen J. Esophageal visualization as an adjunct to the videofluoroscopic study of swallowing. Otolaryngol Head Neck Surg. 152(3):488-93, 2015 Mar. Observational-Dx 111 patients To investigate the prevalence of esophageal abnormalities in an SLP-led videofluoroscopic study of swallowing (VFSS) clinic. Sixty-eight percent of patients had an abnormal esophageal transit. One-third of those referred presented exclusively with esophageal abnormalities, while one-third had both oropharyngeal and esophageal abnormalities. Oral abnormalities, reduced pharyngoesophageal segment maximum opening (PESmax), and increasing age were significantly associated with esophageal abnormalities. 3
13. Martin-Harris B, Brodsky MB, Michel Y, et al. MBS measurement tool for swallow impairment--MBSImp: establishing a standard. Dysphagia. 23(4):392-405, 2008 Dec. Observational-Dx 300 patients To  test reliability, content, construct, and external validity of a new modified barium swallowing study (MBSS) tool (MBSImp) that is used to quantify swallowing impairment Main outcome measures were the MBSImp and index scores of aspiration, health status, and quality of life. Inter- and intrarater concordance were 80% or greater for blinded scoring of MBSSs. Regression analysis revealed contributions of eight of nine swallow types to impressions of overall swallowing impairment (p < or = 0.05). Factor analysis revealed 13 significant components (loadings >/= 0.5) that formed two impairment groupings (oral and pharyngeal). Significant correlations were found between Oral and Pharyngeal Impairment scores and Penetration-Aspiration Scale scores, and indexes of intake status, nutrition, health status, and quality of life. 3
14. Martin-Harris B, Jones B. The videofluorographic swallowing study. Phys Med Rehabil Clin N Am. 19(4):769-85, viii, 2008 Nov. Review/Other-Dx N/A To describe the evidence for the physiologic foundation and interpretation of the videofluorographic swallowing study (VFSS). No results stated in the abstract. 4
15. Levine MS, Rubesin SE. Radiologic investigation of dysphagia. AJR Am J Roentgenol. 1990; 154(6):1157-1163. Review/Other-Dx N/A Presents a practical approach for radiologic investigation of dysphagia. The radiologic examination of the pharynx and esophagus should be tailored according to the nature and location of dysphagia. 4
16. Smith DF, Ott DJ, Gelfand DW, Chen MY. Lower esophageal mucosal ring: correlation of referred symptoms with radiographic findings using a marshmallow bolus. AJR Am J Roentgenol. 1998; 171(5):1361-1365. Review/Other-Dx 130 patients To determine the prevalence of lower esophageal mucosal rings and to correlate the relationship between these mucosal rings and the presence and anatomic level of symptoms evoked using a marshmallow bolus. Lower esophageal mucosal rings were shown in 26 (20%) of the patients. In 16 (62%) of the 26 patients, a marshmallow bolus became impacted at the ring. The impaction caused dysphagia in 12 (75%) of the 16 patients. In these 12 patients, dysphagia was referred to: 7- in the neck, 2- sternal angle, 2- mid chest, and 1- the lower chest. None of the 12 patients had a pharyngeal or cervical esophageal abnormality that would account for their symptoms. Because proximal referral of symptoms is common in patients with lower esophageal mucosal rings, a thorough radiographic examination of the entire esophagus and esophagogastric region is required regardless of the level of their swallowing complaints. 4
17. Schima W, Pokieser P, Schober E, et al. Globus sensation: value of static radiography combined with videofluoroscopy of the pharynx and oesophagus. Clin Radiol. 1996; 51(3):177-185. Observational-Dx 130 patients To determine diagnostic value of static images combined with videofluoroscopy vs either technique alone in patients with globus sensation. Videofluoroscopy combined with static images revealed significantly more abnormalities in pharynx and esophagus than either technique alone. 3
18. Scharitzer M, Pokieser P, Schober E, et al. Morphological findings in dynamic swallowing studies of symptomatic patients. Eur Radiol. 2002;12(5):1139-1144. Observational-Dx 3193 patients To assess the role of videofluoroscopy in the detection of structural abnormalities of the pharynx and esophagus in patients with different symptoms of impaired deglutition. Videofluoroscopy revealed 1040 structural abnormalities in 833 patients (26%) including mass lesions from the oral cavity to hyoid/larynx ( n=66), pharyngeal diverticula ( n=181), pharyngeal masses ( n=78), other pharyngeal narrowings ( n=71), webs ( n=98), masses ( n=39), and other narrowings ( n=73) of the upper esophageal sphincter, esophageal diverticula ( n=80), esophageal webs, rings and strictures ( n=194), and intrinsic and extrinsic esophageal lesions ( n=160). 3
19. Madhavan A, Carnaby GD, Crary MA. 'Food Sticking in My Throat': Videofluoroscopic Evaluation of a Common Symptom. Dysphagia. 30(3):343-8, 2015 Jun. Observational-Dx 141 patients To review corresponding videofluoroscopic swallowing studies for patients with symptoms of 'food sticking in the throat' for accuracy of symptom localization, identification and characteristics (anatomic, physiologic) of an explanatory cause for the symptom, and the specific swallowed material that identified the explanatory cause. Prevalence of explanatory findings on fluoroscopy was 76% (107/141). Eighty five percent (91/107) of explanatory causes were physiologic in nature, while 15% (16/107) were anatomic. The majority of explanatory causes were identified in the esophagus (71%). Symptom localization was more accurate when the explanatory cause was anatomic versus physiologic (75 vs. 18%). A non-masticated marshmallow presented with the highest diagnostic yield in identification of explanatory causes (71%). Patients complaining of 'food sticking in the throat' are likely to present with esophageal irregularities. 4
20. Levine MS, Chu P, Furth EE, Rubesin SE, Laufer I, Herlinger H. Carcinoma of the esophagus and esophagogastric junction: sensitivity of radiographic diagnosis. AJR Am J Roentgenol. 1997; 168(6):1423-1426. Observational-Dx 50 patients To determine sensitivity of double contrast esophagram in diagnosing cancer of esophagus and esophagogastric junction. Double contrast esophagography had sensitivity of 96% in diagnosing these tumors. 3
21. DiPalma JA, Prechter GC, Brady CE, 3rd. X-ray-negative dysphagia: is endoscopy necessary? J Clin Gastroenterol. 1984; 6(5):409-411. Review/Other-Dx 195 patients To determine if endoscopy increased chances of finding esophageal cancer in patients with radiographic-negative dysphagia. No cases of esophageal cancer found by endoscopy that had been missed on barium study. 4
22. Halpert RD, Feczko PJ, Spickler EM, Ackerman LV. Radiological assessment of dysphagia with endoscopic correlation. Radiology. 1985; 157(3):599-602. Observational-Dx 127 patients To determine frequency of abnormalities on biphasic esophagrams in patients with dysphagia and correlate with endoscopy. 77% of patients with dysphagia had abnormal barium studies; 3.3% had esophageal cancer; no cancers missed on barium study. 3
23. Ott DJ, Chen YM, Wu WC, Gelfand DW, Munitz HA. Radiographic and endoscopic sensitivity in detecting lower esophageal mucosal ring. AJR Am J Roentgenol.  1986; 147(2):261-265. Observational-Dx 60 patients To compare radiographic and endoscopic sensitivities in patients with lower esophageal rings. 95% of lower esophageal rings detected by barium esophagography vs 76% by endoscopy. Radiographic examination more accurate. 3
24. Ott DJ, Chen YM, Wu WC, Gelfand DW. Endoscopic sensitivity in the detection of esophageal strictures. J Clin Gastroenterol. 1985; 7(2):121-125. Observational-Dx 90 patients To determine endoscopic sensitivity in detecting peptic esophageal strictures. Barium studies detected 95% of all strictures. Endoscopy and radiology are equally effective and complementary methods. 3
25. Ott DJ, Gelfand DW, Lane TG, Wu WC. Radiologic detection and spectrum of appearances of peptic esophageal strictures. J Clin Gastroenterol. 1982; 4(1):11-15. Observational-Dx 80 patients To compare radiology and endoscopy in diagnosis of peptic strictures. Radiology detected 95% of all strictures. 3
26. Ott DJ, Richter JE, Chen YM, Wu WC, Gelfand DW, Castell DO. Esophageal radiography and manometry: correlation in 172 patients with dysphagia. AJR Am J Roentgenol. 1987; 149(2):307-311. Observational-Dx 172 patients To correlate radiographic and manometric findings in patients with dysphagia. Barium studies had overall sensitivity of 89% and specificity of 91% in diagnosing esophageal motility disorders. 3
27. Amaravadi R, Levine MS, Rubesin SE, Laufer I, Redfern RO, Katzka DA. Achalasia with complete relaxation of lower esophageal sphincter: radiographic-manometric correlation. Radiology. 2005; 235(3):886-891. Observational-Dx 21 patients Retrospective study to evaluate presence of complete lower esophageal sphincter relaxation on manometry in patients with achalasia on barium studies. Nearly one-third of patients with achalasia on barium studies had complete lower esophageal sphincter relaxation on manometry and symptoms resolved in all after treatment for achalasia. 3
28. Barloon TJ, Bergus GR, Lu CC. Diagnostic imaging in the evaluation of dysphagia. Am Fam Physician. 1996; 53(2):535-546. Review/Other-Dx N/A Reviews causes of oropharyngeal and esophageal dysphagia. Advocates barium study for diagnosing these lesions. 4
29. Andersson M, Lundell L, Kostic S, et al. Evaluation of the response to treatment in patients with idiopathic achalasia by the timed barium esophagogram: results from a randomized clinical trial. Dis Esophagus. 2009; 22(3):264-273. Observational-Tx 51 patients To assess the ability of TBE to predict symptoms and treatment failure during post-treatment follow-up and to determine whether esophageal emptying as assessed by TBE differs after treatment with pneumatic dilatation or laparoscopic myotomy. 51 patients with newly diagnosed achalasia were prospectively randomized to pneumatic dilatation (n=26) or laparoscopic myotomy (n=25). Evaluation with TBE was performed before (n=46) and after treatment (n=43). The median interval between treatment and post-treatment TBE was 6 months, and the median follow-up time after the post-treatment TBE was 18 months. Following therapeutic intervention, TBE parameters did not differ significantly between treatment groups. However, significant correlations were found between the height of the barium column at 1 min and the symptom scores at the end of follow-up for 'dysphagia for liquids' (P<0.05, rho = 0.47), 'chest pain' (P<0.05, rho = 0.42), and the 'Watson dysphagia score' (P<0.05, rho = 0.46). Patients with <50% improvement in this TBE-parameter (height at 1 min) post-treatment had a 40% risk of treatment failure during follow-up. 1
30. de Oliveira JM, Birgisson S, Doinoff C, et al. Timed barium swallow: a simple technique for evaluating esophageal emptying in patients with achalasia. AJR Am J Roentgenol. 1997; 169(2):473-479. Observational-Dx 23 patients To define a simple technique for timing a barium swallow by which radiologists can assess esophageal emptying in patients with achalasia before and after minimally invasive therapy. There was no statistically significant difference between the percentage of emptying as measured on the digitized images and the H x W calculations or qualitative emptying percentage. Interobserver agreement for the area evaluated on the digitized films as well as the H x W measurements and qualitative estimates of emptying was almost perfect (the correlation coefficients being 0.99, 0.87, and 0.93, respectively). Both qualitative assessment and estimated change in area based on H x W measurements of the barium column are accurate methods of estimating esophageal emptying. 3
31. Paramsothy M, Goh KL, Kannan P. Oesophageal motility disorders: rapid functional diagnosis using computerised radionuclide oesophageal transit study. Singapore Med J. 1995; 36(3):309-313. Review/Other-Dx 10 patients To evaluate radionuclide esophageal transit studies for diagnosing esophageal dysmotility in patients with chest pain or dysphagia. All 10 patients had accurate diagnosis of esophageal dysmotility with this technique. 4
32. Stacey B, Patel P. Oesophageal scintigraphy for the investigation of dysphagia: in ans out of favour - underused when available. Eur J Nucl Med Mol Imaging. 2002; 29(9):1216-1220. Review/Other-Dx N/A Reviews role of radionuclide esophageal studies in patients with dysphagia. Esophageal scintigraphy is a simple, rapid, noninvasive test for assessing esophageal transit and function in a quantifiable way in patients with dysphagia. 4
33. Bhaijee F, Subramony C, Tang SJ, Pepper DJ. Human immunodeficiency virus-associated gastrointestinal disease: common endoscopic biopsy diagnoses. Patholog Res Int. 2011; 2011:247923. Review/Other-Dx N/A To review HIV associated gastrointestinal pathology with emphasis on common endoscopic biopsy diagnoses. No results stated in abstract. 4
34. Werneck-Silva AL, Prado IB. Role of upper endoscopy in diagnosing opportunistic infections in human immunodeficiency virus-infected patients. World J Gastroenterol. 2009; 15(9):1050-1056. Review/Other-Dx N/A To provide an update of the role of endoscopy in diagnosing opportunistic infection in the upper gastrointestinal tract in HIV-infected patients in the era of highly active antiretroviral therapy. Highly active antiretroviral therapy has dramatically decreased opportunistic infections in HIV-infected patients. However, gastrointestinal disease continues to account for a high proportion of presenting symptoms in these patients. Gastrointestinal symptoms in treated patients who respond to therapy are more likely to the result of drug-induced complications than opportunistic infection. Endoscopic evaluation of the gastrointestinal tract remains a cornerstone of diagnosis, especially in patients with advanced immunodeficiency, who are at risk for opportunistic infection. The peripheral blood CD4 lymphocyte count helps to predict the risk of an opportunistic infection, with the highest risk seen in HIV-infected patients with low CD4 count (<200 cells/mm(3)). 4
35. Balthazar EJ, Megibow AJ, Hulnick D, Cho KC, Beranbaum E. Cytomegalovirus esophagitis in AIDS: radiographic features in 16 patients. AJR Am J Roentgenol. 1987; 149(5):919-923. Review/Other-Dx 16 patients To assess radiographic findings in patients with CMV esophagitis. CMV esophagitis characterized by solitary or multiple ulcers, often large or deep. 4
36. Levine MS, Loevner LA, Saul SH, Rubesin SE, Herlinger H, Laufer I. Herpes esophagitis: sensitivity of double-contrast esophagography. AJR Am J Roentgenol. 1988; 151(1):57-62. Review/Other-Dx 25 patients To determine radiographic accuracy of double contrast esophagography in diagnosing herpes esophagitis. Abnormalities almost always detected on double contrast studies and in more than 50% of cases a specific diagnosis of herpes esophagitis could be made. 4
37. Levine MS, Macones AJ, Jr., Laufer I. Candida esophagitis: accuracy of radiographic diagnosis. Radiology. 1985; 154(3):581-587. Review/Other-Dx 34 patients Retrospective study to determine sensitivity of double contrast esophagram in diagnosing Candida esophagitis. Double contrast esophagography had sensitivity of 88%. 4
38. Vu KN, Day TA, Gillespie MB, et al. Proximal esophageal stenosis in head and neck cancer patients after total laryngectomy and radiation. ORL J Otorhinolaryngol Relat Spec. 2008;70(4):229-235. Observational-Tx 33 patients To evaluate the incidence of late proximal esophageal stricture in patients undergoing total laryngectomy (TL) and radiation therapy (RT). The median follow-up was 28 months. At the last follow-up, 25 patients (76%) were alive and disease free. Four had died and 3 developed distant metastasis. Dysphagia or stenosis developed in 40% in group 1 and 75% in group 2 patients. The median time to dysphagia was 5.5 months for all patients. 2
39. Roh S, Iannettoni MD, Keech JC, Bashir M, Gruber PJ, Parekh KR. Role of Barium Swallow in Diagnosing Clinically Significant Anastomotic Leak following Esophagectomy. Korean J Thorac Cardiovasc Surg. 2016;49(2):99-106. Observational-Dx 350 esophagectomies To evaluate the reliability of the barium swallow study in diagnosing anastomotic leaks following esophagectomy. The indications for the esophagectomy were as follows: malignancy (n=320), high-grade dysplasia (n=14), perforation (n=27), benign stricture (n=7), achalasia (n=16), and other (n=11). A variety of techniques were used including transhiatal (n=351), McKeown (n=35), and Ivor Lewis (n=9) esophagectomies. Operative mortality was 2.8% (n=11). Three hundred and sixty-eight patients (93%) underwent barium swallow study after esophagectomy. Clinically significant anastomotic leak was identified in 36 patients (9.8%). Barium swallow was able to detect only 13/36 clinically significant leaks. The sensitivity of the swallow in diagnosing a leak was 36% and specificity was 97%. The positive and negative predictive values of barium swallow study in detecting leaks were 59% and 93%, respectively. 3
40. Lantos JE, Levine MS, Rubesin SE, Lau CT, Torigian DA. Comparison between esophagography and chest computed tomography for evaluation of leaks after esophagectomy and gastric pull-through. J Thorac Imaging. 28(2):121-8, 2013 Mar. Observational-Dx 29 patients To assess the diagnostic performance of esophagography and chest computed tomography (CT) for detecting leaks after esophagectomy and gastric pull-through. Clinically relevant leaks were present in 14 (48%) of 29 patients after esophagectomy. Esophagography had a sensitivity of 79%, specificity of 73%, PPV of 73%, and NPV of 79% for detecting leaks, whereas CT had a sensitivity of 86%, specificity of 33%, PPV of 55%, and NPV of 71% and esophagography and CT combined had a sensitivity of 100%, specificity of 27%, PPV of 56%, and NPV of 100%. The sensitivity of esophagography increased with high-density barium, whereas the sensitivity of CT was the same with and without oral contrast agent. Finally, esophagography and CT were seen to have a higher sensitivity and lower specificity on retrospective review compared with the results reported at initial image interpretation. 3
41. Harris JA, Bartelt D, Campion M, et al. The use of low-osmolar water-soluble contrast in videofluoroscopic swallowing exams. Dysphagia. 2013;28(4):520-527. Observational-Dx 1978 fluoroscopic exams To document the usage of a nonionic, water-soluble contrast (iohexol) and barium contrast in adult patients undergoing fluoroscopic exams of the pharynx and/or esophagus and provide clinical indications for the use of each. Of these exams, 60.6 % were completed for medical reasons and 39.4 % for surgical reasons. Fifty-five percent of the exams were performed jointly by a SLP and a radiologist and 45 % were performed by a radiologist alone. Aspiration was present in 22 % of the exams, vestibular penetration occurred in 38 %, extraluminal leakage of contrast was observed in 4.6 %, and both aspiration and leakage were seen in 1 % of the exams. In cases with aspiration, iohexol was used alone in 8 %, iohexol and barium were both used in 45 %, and barium was used alone in 47 %. In cases with extraluminal leakage, iohexol was used alone in 58 %, iohexol and barium were both used in 31 %, and barium was used alone in 11 %. No adverse effects were seen with the use of iohexol. When barium was used in cases of aspiration and extraluminal leakage, the amount of aspirated barium was small and the extraluminal barium in the instances of leakage was small. Iohexol is a useful screening contrast agent and can safely provide information, and its use reduces the risk of aspiration and the chance of leakage of large amounts of barium. 4
42. Tanomkiat W, Galassi W. Barium sulfate as contrast medium for evaluation of postoperative anastomotic leaks. Acta Radiol. 2000;41(5):482-485. Observational-Dx 114 postoperative patients To assess the value of barium swallow as a method for immediate re-examination after the failure of an aqueous iodinated agent in detection of clinically suspected postoperative esophageal leakage, and as the initial study in asymptomatic postoperative patients. Leakage was shown with the initial study, using aqueous medium, in 23 patients (20%). The volume of leakage was between 0.05 and 36 cm3 (mean 3.95 cm3). Clinical signs and symptoms presented in 13 cases (56%). Fourteen of 91 patients (15%), who had negative results with the initial study, had evidence of leakage at barium swallow. The leakage volume ranged between 0.06 and 0.53 cm3 (mean 0.18 cm3). Clinical evidence of leakage was shown in 3/14 (21%) cases. No complications were detected over a 6-month period following the study. 3
43. Upponi S, Ganeshan A, D'Costa H, et al. Radiological detection of post-oesophagectomy anastomotic leak - a comparison between multidetector CT and fluoroscopy. Br J Radiol. 2008;81(967):545-548. Observational-Dx 52 patients To directly compare CT with fluoroscopy for the diagnosis of occult anastomotic leak following oesophagectomy. Four were found to have leak on CT and fluoroscopy. 11 had possible leak at CT, but normal fluoroscopy: 2 of these had a leak confirmed later, whereas 9 had no leak. 37 had normal CT and fluoroscopy findings, and remained clinically well. The sensitivity, specificity, positive and negative predictive values were 100%, 80%, 40% and 100%, respectively, for CT, and 67%, 100%, 100% and 96%, respectively, for fluoroscopy. The positive predictive value of mediastinal air, air/fluid and extraluminal contrast were 25%, 75% and 50%, respectively. 35 patients found CT more tolerable. 2
44. Maclean J, Cotton S, Perry A. Post-laryngectomy: it's hard to swallow: an Australian study of prevalence and self-reports of swallowing function after a total laryngectomy. Dysphagia. 2009;24(2):172-179. Observational-Tx 120 questionnaires To investigate the prevalence and nature of self-reported dysphagia following a total laryngectomy across New South Wales (NSW), Australia and to document the effect of dysphagia on the respondents' social activities and participation. Dysphagia was self-reported by 71.8% of the cohort. In this cohort with dysphagia, the most commonly reported features included an increased time required to swallow, a need for fluids to wash down a bolus, and avoidance of certain food consistencies. Severe distress was reportedly associated with dysphagia for 39.7% of these respondents and prevented 57% of them from participating in social activities, such as eating at friends' houses and/or at restaurants. The prevalence of self-reported dysphagia following total laryngectomy in this Australian study was 72%. 4
45. Santini L, Robert D, Lagier A, Giovanni A, Dessi P, Fakhry N. A videofluoroscopic study comparing severe swallowing disorders in patients treated surgically or with radiation for oropharyngeal cancer. Int J Oral Maxillofac Surg. 44(6):705-9, 2015 Jun. Observational-Tx 26 patients To analyze the causal mechanisms of severe swallowing disorders after the treatment of oropharyngeal cancer. Videofluoroscopy analysis showed a localized alteration in the surgical excision area resulting in impaired tongue root retraction in the surgical group (P=0.012), while general impairment of the pharyngeal, laryngeal, and upper oesophagus sphincter was found in the non-surgical group. Aspirations in the surgical group most often occurred after swallowing, while in the non-surgical group, they occurred during and after swallowing (P=0.039). 2
46. Coffey M, Tolley N. Swallowing after laryngectomy. Curr Opin Otolaryngol Head Neck Surg. 2015;23(3):202-208. Review/Other-Tx N/A To examine the emergence of dysphagia as an area for rehabilitation postlaryngectomy and to describe the use of dysphagia evaluation tools postlaryngectomy and the causes of dysphagia. No results stated in abstract. 4
47. Samlan RA, Webster KT. Swallowing and speech therapy after definitive treatment for laryngeal cancer. [Review] [104 refs]. Otolaryngol Clin North Am. 35(5):1115-33, 2002 Oct. Review/Other-Tx N/A To discuss voice and swallowing therapy as necessary components of the rehabilitation process following treatment for head and neck cancers. No results stated in abstract. 4
48. Kim TJ, Lee KH, Kim YH, et al. Postoperative imaging of esophageal cancer: what chest radiologists need to know. [Review] [77 refs]. Radiographics. 27(2):409-29, 2007 Mar-Apr. Review/Other-Dx N/A To review various surgical techniques used in esophageal cancer surgery and discuss and illustrate the imaging features associated with a variety of postoperative anatomic changes, intra- and postoperative complications, and tumor recurrence. No results stated in abstract. 4
49. Carucci LR, Turner MA, Yeatman CF. Dysphagia secondary to anterior cervical fusion: radiologic evaluation and findings in 74 patients. AJR Am J Roentgenol. 204(4):768-75, 2015 Apr. Observational-Dx 1789 patients To assess the frequency, cause, and time course of dysphagia after anterior cervical fusion (ACF). Dysphagia was evaluated radiologically in 74 of the 1789 ACF patients (4.1%) using video MBS studies (n=66) and esophagography (n=26). Patients underwent radiologic evaluation from 1 to 1150 days after surgery (mean, 120 days after surgery); 76% of the patients presented more than 2 weeks after surgery. The location of the ACF in the study group was the upper, mid, and lower cervical spine in 5.4% (n=4), 55.4% (n=41), and 39.2% (n=29) of patients, respectively. Soft-tissue swelling with displacement of the pharynx or esophagus was identified in 91% of patients (n=67). More serious complications of ACF that resulted in dysphagia included surgical hardware displacement or bone graft displacement (n=18), esophageal perforation (n=3), and a retropharyngeal abscess (n=3). Pharyngeal functional abnormalities were detected in 50 patients, with penetration, aspiration, or both seen in 32. 4
50. American College of Radiology. ACR Appropriateness Criteria® Radiation Dose Assessment Introduction. Available at: https://www.acr.org/-/media/ACR/Files/Appropriateness-Criteria/RadiationDoseAssessmentIntro.pdf. Review/Other-Dx N/A To provide evidence-based guidelines on exposure of patients to ionizing radiation. No abstract available. 4
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