Retrospective Cohort Study
Copyright ©The Author(s) 2016. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Endosc. Mar 25, 2016; 8(6): 288-294
Published online Mar 25, 2016. doi: 10.4253/wjge.v8.i6.288
Determination of the cut-off score of an endoscopic scoring method to predict whether elderly patients with dysphagia can eat pureed diets
Torao Sakamoto, Akira Horiuchi, Toshiyuki Makino, Masashi Kajiyama, Naoki Tanaka, Masamitsu Hyodo
Torao Sakamoto, Department of Rehabilitation, Showa Inan General Hospital, Komagane 399-4117, Japan
Akira Horiuchi, Toshiyuki Makino, Masashi Kajiyama, Naoki Tanaka, Digestive Disease Center, Showa Inan General Hospital, Komagane 399-4117, Japan
Masamitsu Hyodo, Department of Otolaryngology, Head and Neck Surgery, Kochi Medical School, Kochi Prefecture 783-8505, Japan
Author contributions: All the authors contributed to this paper.
Institutional review board statement: The study was reviewed and approved for publication by our Institutional Reviewer.
Informed consent statement: All study participants or their legal guardian provided informed written consent about personal and medical data collection prior to study enrolment.
Conflict-of-interest statement: All the Authors have no conflict of interest related to the manuscript.
Data sharing statement: The original anonymous dataset is available on request from the corresponding author at horiuchi.akira@sihp.jp.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Akira Horiuchi, MD, Digestive Disease Center, Showa Inan General Hospital, 3230 Akaho, Komagane 399-4117, Japan. horiuchi.akira@sihp.jp
Telephone: +81-265-822121 Fax: +81-265-822118
Received: October 26, 2015
Peer-review started: October 27, 2015
First decision: December 11, 2015
Revised: December 21, 2015
Accepted: January 16, 2016
Article in press: January 19, 2016
Published online: March 25, 2016
Abstract

AIM: To identify the cut-off value for predicting the ability of elderly patients with dysphagia to swallow pureed diets using a new endoscopy scoring method.

METHODS: Endoscopic swallowing evaluation of pureed diets were done in patients ≥ 65 years with dysphagia. The Hyodo-Komagane score for endoscopic swallowing evaluation is expressed as the sum (0-12) of four degrees (0-3) with four parameters: (1) salivary pooling in the vallecula and piriform sinuses; (2) the response of glottal closure reflex induced by touching the epiglottis with the endoscope; (3) the location of the bolus at the time of swallow onset assessed by “white-out” following swallowing of test jelly; and (4) pharyngeal clearance after swallowing of test jelly. We used receiver operating characteristic (ROC) curve analysis to retrospectively analyze the association between the total score and successful oral intake of pureed diets.

RESULTS: One hundred and seventy-eight patients were enrolled including 113 men (63%), mean age 83 years (range, 66-98). One hundred and twenty-six patients (71%) were able to eat pureed diets during the observation period (mean ± SD, 19 ± 14 d). In ROC analysis, the cut-off value of the score for eating the pureed diets was 7 (sensitivity = 0.98; specificity = 0.91).

CONCLUSION: The Hyodo-Komagane endoscopic score is useful to predict the ability to eat pureed diets in elderly patients with dysphagia.

Keywords: Dysphagia, Endoscopy, Pureed diets, Percutaneous endoscopic gastrostomy

Core tip: Predicting successful oral intake in elderly patients with dysphagia remains a challenge. The scoring method for endoscopic swallowing evaluation was based on final score (from 0 to 12) using four parameters; (1) the salivary pooling in the vallecula and piriform sinuses; (2) the response of glottal closure reflex induced by touching the epiglottis with the endoscope; (3) the location of the bolus at the time of swallow onset assessed by “white-out” after the swallowing of test jelly; and (4) the extent of pharyngeal clearance after test jelly is swallowed. A total score of 7 or less during endoscopic swallowing evaluation reliably predicted the ability to eat pureed diets.