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The contrast swallow study: a sub-optimal investigation for identifying pharyngocutaneous fistula following laryngectomy
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The contrast swallow study: a sub-optimal investigation for identifying pharyngocutaneous fistula following laryngectomy
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Journal Article
The contrast swallow study: a sub-optimal investigation for identifying pharyngocutaneous fistula following laryngectomy
2025
Overview
This article aimed to evaluate the diagnostic accuracy of the contrast swallow study and its role in informing management decisions in patients following laryngectomy.
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.
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.
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.
