2006 Volume 10 Issue 2 Pages 152-160
No standardized method for evaluation of esophageal findings on videofluoroscopic examination of swallowing (VF) has yet been suggested．Esophageal residue is recognized on videofluoroscopic examination of swallowing (VF) in many cases．We attempted to classify and evaluate esophageal residue．Methods of removing esophageal residue，if present，were also investigated．【Subjects】The subjects were 234 patients (160 men and 74 women，with a mean age of 73.1 years) with dysphagia，who received VF during the 1.5-year period between October 2003 and April 2005 and could be observed until the esophageal stage．The underlying diseases were cerebrovascular accident in 98 and pneumonia in 62 of these subjects．【Methods】The subjects were instructed to swallow 3ml of 40％ barium sulfate (viscosity：about 5300 cp)，which was thickened with a thickener，at various angles (30，45，60，and 90 degrees) of the body trunk，at which the best pharyngeal swallowing was recognized，and esophageal residue was evaluated in terms of the following 4 items on en face views：1) Extent of residue (Residue 1： None-slight，Residue 2： Moderate，Residue 3： Extensive)； 2）site of residue [upper esophagus (1/3)，middle esophagus (1/3)，lower esophagus (1/3)，upper to middle esophagus (2/3)，middle to lower esophagus (2/3)，and whole esophagus]； 3） presence/absence of intraesophageal reflux；and 4）methods for residue removal [ (a) Dry swallowing，(b) elevation of the angle of the body trunk + dry swallowing，(c) swallowing gelatinized slices (food bolus) without chewing，and (d) intake of 40％ barium liquid]．
【Result】We could classify each esophageal residue with this method．Esophageal residue was recognized in 73.5％ (172) of the subjects．With regard to the residue sites，the highest proportion，39％ (68) of the subjects，had residue throughout the esophagus，followed by 24％ (41) with residue in the middle to lower esophagus (2/3)．Intra-esophageal reflux was recognized in more than half of the subjects with residue．Although methods for removing esophageal residue，(a) to (d) described above，were effective，the selected method needs to be tailored for individual patients．We consider esophageal residue to correlate with esophagolaryngeal reflux and pharyngolaryngeal reflux．Methods of standardization for evaluating esophageal findings on VF are considered to promote simplification of evaluation of the esophageal stage and thereby to contribute to clinical studies of the stage．
