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The contrast swallow study: a sub-optimal investigation for identifying pharyngocutaneous fistula following laryngectomy

Published online by Cambridge University Press:  27 March 2025

Henry Lonsdale Open the ORCID record for Henry Lonsdale [Opens in a new window] ,
Kristijonas Milinis ,
Alexandra Bell ,
Katharine Davies ,
Christopher Loh  and
Jason C. Fleming
Henry Lonsdale*
Affiliation:
Liverpool Head and Neck Centre, Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK
Kristijonas Milinis
Affiliation:
Liverpool Head and Neck Centre, Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK
Alexandra Bell
Affiliation:
Liverpool Head and Neck Centre, Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK
Katharine Davies
Affiliation:
Liverpool Head and Neck Centre, Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK
Christopher Loh
Affiliation:
Liverpool Head and Neck Centre, Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK
Jason C. Fleming
Affiliation:
Liverpool Head and Neck Centre, Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK University of Liverpool, Liverpool, Merseyside, UK
*
Corresponding author: Henry Lonsdale; Email: hplonsdale@doctors.org.uk
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Abstract

Objectives

This article aimed to evaluate the diagnostic accuracy of the contrast swallow study and its role in informing management decisions in patients following laryngectomy.

Methods

A five-year retrospective case note review on all patients who underwent laryngectomy between April 2018 and July 2023 at a tertiary head and neck cancer centre.

Results

A total of 82 patients met inclusion criteria; 22 had reported radiological evidence of a pharyngocutaneous fistula on contrast swallow study; of these only 1 developed a clinical pharyngocutaneous fistula. Of the 60 with no radiological evidence of a pharyngocutaneous fistula, 3 developed clinical pharyngocutaneous fistulas. This represents a positive predictive value of 5 per cent and a negative predictive value of 95 per cent.

Conclusion

In this cohort, the contrast swallow study was a sub-optimal investigation. The high NPV may support decision-making when there is little clinical suspicion, however the low PPV represents significant over-reporting and may cloud the clinical decision-making process.

Keywords

contrast swallow studylaryngectomyoralfeedingpharyngocutaneous fistula
Type
Main Article
Information
The Journal of Laryngology & Otology , First View , pp. 1 - 6
Copyright
© The Author(s), 2025. Published by Cambridge University Press on behalf of J.L.O. (1984) LIMITED.

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Footnotes

Henry Lonsdale takes responsibility for the integrity of the content of the paper

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