The Effect of Balloon Dilation at the Vallecular Using Videofluoroscopic Swallowing Study on Patient Who Has a Dysphagia
A 72-year-old male patient with stomach cancer and S-phase colon cancer received ileostomy along with gastrectomy and proctocolectomy for cancer removal, followed by concentrated observation treatment in the intensive care unit, during which, dyspnea occurred suddenly. After intubation and artificial venting by a respirator, respiration-related symptoms were improved and spontaneous respiration became possible after removing the respirator. However, dysphagia occurred, and he was admitted by the department rehabilitation medicine in the present hospital for comprehensive rehabilitation treatment. Although the patient did not have a past history of high blood pressure or diabetes, he had a history of drinking alcohol 4 times a week and smoking for 40 pack years, and was taking warfarin due to atrial fibrillation. He had a history of receiving percutaneous transluminal coronary angioplasty due to angina pectoris. According to a physical exam, no particular finding was observed other than weakness of the whole body.\nThe patient had received a continuous nutrition supply through total parenteral nutrition for more than 2 months since the first onset, and changed nutrition supply to tube feeding through nasogastric tubing after being hospitalized by the present hospital, followed by continued exercise promoting tongue's posterior movement and laryngeal elevation through occupational therapy. After that, VFSS was conducted to analyze the possibility of oral nutrition, during which, a large quantity of remnant epiglottis vallecula was observed without, however, a finding for aspiration so that nasogastric tubing was removed and oral nutrition was attempted through a compensation technique. Since then, however, there was a complaint of continued dysphagia during eating, and esophagogastroduodenoscope (EGD) examination was conducted through a consultation with the division of gastroenterology for a detailed cause analysis. From the EGD examination, no finding of mechanical closure of esophagus or stomach was observed. For a more accurate diagnosis, esophageal pressure manometry was conducted, which indicated normal findings for both the length of the upper and lower esophagus sphincter muscles or the resting pressure, as well as coordination of the esophagus during swallowing and fluid changes. Following that, VFSS was conducted again and a comparative analysis with the previous study images was made. The result of which led to a judgment that epiglottis was not bent back toward posterior inferior so that foods did not pass to the esophagus, Hence, an intervention was conducted where the epiglottis was physically stretched and spread in the direction of posterior inferior, using a urethral catheter. Intervention involved first implementation of the swallowing test, positioning a 16 F urethral catheter in the epiglottis vallecula, and subsequently expanding the balloon, as well as stretching and spreading of the epiglottis for 1 minute using about 5 mL of a contrast medium for balloon expansion; followed by rest for 10 seconds, which were repeated for a total of 3 times for the treatment (). Thereafter, swallowing test was again conducted to make judgment on the treatment effects (, ).\nSince then, an improvement in dysphagia symptoms was indicated with the ability of eating semisolid foods, and stretching and spreading treatment of the epiglottis was continued with progress observation. In addition, the use of a urethral catheter was accompanied by re-implementation of VFSS once a week. As a result, improvement was made to the extent of being able to eat solid foods, allowing discharge from the hospital.