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2 results

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

  • Henry Lonsdale, Kristijonas Milinis, Alexandra Bell, Katharine Davies, Christopher Loh, Jason C. Fleming
  • Journal:
    The Journal of Laryngology & Otology / Volume 139 / Issue 7 / July 2025
    Published online by Cambridge University Press:
    27 March 2025, pp. 597-602
    Print publication:
    July 2025
  • 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.