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Improving screening for oesophageal abnormalities

Improving screening for oesophageal abnormalities


GOAL:
Investigate the prevalance of oesophageal abnormalities in our Videofluoroscopic Study of Swallowing (VFSS) clinics

Why?

  • On average 300 patients per year with complaints of difficulty swallowing (dysphagia) are referred to speech-language therapists for a videofluoroscopic study of swallowing (VFSS)
  • The VFSS procedure traditionally screens the mouth and throat (oropharynx) but does not screen the oesophagus

What did we find?

  • Many patients referred to speech-language therapists are later diagnosed with oesophageal dysphagia
  • Standard VFSS screening alone will not diagnose patients with oesophageal dysphagia  so patients often receive multiple investigations before it is diagnosed

What did we do?

In collaboration with the Speech Science department from the University of Auckland we conducted a study of over 100 patients referred to speech-language therapists where we performed a VFSS and included an oesophageal screen. Results showed that:

  • 68% of patients had oesophageal abnormalities
  • 31% of these patients had only oesophageal abnormalities (39% had oesophageal abnormalities alongside other abnormalities)

Did we make a difference?

  • 31% of patients in the study were properly diagnosed with oesophageal problems when they would have been sent home with no diagnosis prior to the inclusion of oesophageal screening in the VFSS clinic
  • These patients were prevented from having an expensive range of further procedures (such as endoscopy or gastroscopy) and a delay in diagnosis

Resulting changes to VFSS clinic:

All speech-language therapists are trained in oesophageal screening

All patients referred for VFSS receive an oesophageal screen

Multidisciplinary panel now meets monthly to review complex cases

Fortnightly VFSS clinic for rapid screening and referral to relevant services


Acknowledgements:

  • Dr Anna Miles and Jessica McMillan, University of Auckland
  • Jacqui Allen, Katie Ward, Becca Hammond, Waitemata DHB

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