- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT03368079
Utilization of Negative Pressure Suction to Reduce Aspiration in Oropharyngeal Dysphagia
Study Overview
Status
Conditions
Intervention / Treatment
Detailed Description
During a properly coordinated swallow, the oropharynx, larynx, and hypopharynx undergo a series of movements that serve to prepare and expand the pharyngoesophageal segment (PES), which is the inlet into the esophagus. Under normal circumstances, a food bolus is safely propelled from the oropharynx, through the PES, and into the esophagus. Surgical and radiation therapy in the head and neck, as well as deficiencies such as poor coordination, mistiming, or obstructing lesions may prevent the food bolus from safely entering the esophagus and instead diverting toward the trachea.
A number of patients with severe oropharyngeal dysphagia are not able to tolerate any diet without risking aspiration and subsequent pneumonia, often to a degree severe enough that they cannot manage to safely swallow their secreted saliva. These patients depend on a gastrostomy feeding tube in order to obtain adequate daily nutritional requirements and must suction or spit out their saliva to prevent aspiration and a sensation of asphyxiation. Despite these precautions, many of these patients ultimately suffer life-threatening pneumonia. Investigators will be testing if the use of use of a negative pressure suction in the hypopharynx will reduce the amount of aspiration during Video Fluoroscopic Swallowing Exam (VFSE) among patients with severe oropharyngeal dysphagia
Study Type
Enrollment (Estimated)
Phase
- Not Applicable
Contacts and Locations
Study Contact
- Name: Randev Sandhu, BS
- Phone Number: 916-734-2863
- Email: rssandhu@ucdavis.edu
Study Locations
-
-
California
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Sacramento, California, United States, 95817
- Recruiting
- UC Davis Medical Center
-
Contact:
- Randev Sandhu, BS
- Phone Number: 916-734-2863
- Email: rssandhu@ucdavis.edu
-
-
Participation Criteria
Eligibility Criteria
Ages Eligible for Study
Accepts Healthy Volunteers
Description
Inclusion Criteria:
- Patients with videofluoroscopic evidence of aspiration with Rosenbek Penetration Aspiration Scale (PAS) greater than 5 for all tested food consistencies
- Gastrostomy tube dependence
- Exhaustion of conventional treatment options (physical, medical, and surgical therapies)
Exclusion Criteria:
- Complete PES stricture
- Inability to follow commands
- Current malignant disease
- No gastrostomy tube present
- Less than two years of cancer-free survival (if applicable)
- Vulnerable populations: adults unable to consent, pregnant women, and prisoners
Study Plan
How is the study designed?
Design Details
- Primary Purpose: Supportive Care
- Allocation: N/A
- Interventional Model: Single Group Assignment
- Masking: None (Open Label)
Arms and Interventions
Participant Group / Arm |
Intervention / Treatment |
---|---|
Experimental: Negative Pressure Suction Device
|
The negative pressure suction device to be used in the study will be a Foley catheter.
The catheter will be placed through the gastrostomy tube site, directed retrograde through the esophagus, and terminating in the PES.
|
What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Degree of aspiration
Time Frame: During VFSE, from the beginning of administration of the first bolus size to completion of the VFSE
|
Degree of aspiration or laryngeal penetration, evaluated by the validated Rosenbek Penetration-Aspiration Scale (PAS). The PAS scale is an 8-point (1 to 8), equal-appearing interval scale:
|
During VFSE, from the beginning of administration of the first bolus size to completion of the VFSE
|
Pharyngo-esophageal Segment (PES) opening size
Time Frame: During VFSE, PES is measured when the patient administers 20 cc of liquid barium and the PES is maximally distended.
|
Pharyngo-esophageal Segment (PES) is a 2.5 to 4.5 cm manometric high-pressure zone located between the pharynx and esophagus.
Normal Pharyngoesophageal segment opening size on lateral view: 0.80 cm +/- 0.40 cm
|
During VFSE, PES is measured when the patient administers 20 cc of liquid barium and the PES is maximally distended.
|
Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Pharyngeal Constriction Ratio (PCR)
Time Frame: Measurement of the pharyngeal area during maximum contraction are taken after administration of 20 cc liquid barium. The pharyngeal area at rest is measured when 1 cc bolus is held in the oral cavity.
|
Pharyngeal Constriction Ratio: is a measure of pharyngeal clearance pressure.
It is calculated by dividing the lateral pharyngeal area during maximal contraction by the area with a 1 cc bolus held in the oral cavity.
The area is determined by onscreen tool provided.
Normal PCR: 0.14 +/- 0.28
|
Measurement of the pharyngeal area during maximum contraction are taken after administration of 20 cc liquid barium. The pharyngeal area at rest is measured when 1 cc bolus is held in the oral cavity.
|
Oropharyngeal transit time
Time Frame: Time from when bolus head first passes posterior nasal spine to time bolus head enters base of vallecula
|
Oropharyngeal transit time is measured when the patient administers 20 cc of liquid barium.
Normal oropharyngeal transit time: 0.42 sec +/- 0.36 sec
|
Time from when bolus head first passes posterior nasal spine to time bolus head enters base of vallecula
|
Hypopharyngeal transit time
Time Frame: Time from when bolus head exits the vallecula to time when bolus tale exits PES
|
Hypopharyngeal transit time: is measured when the patient administers 20 cc of liquid barium.
Normal Hypopharyngeal transit time: 0.77 sec +/- 0.26 sec
|
Time from when bolus head exits the vallecula to time when bolus tale exits PES
|
Collaborators and Investigators
Sponsor
Publications and helpful links
Helpful Links
Study record dates
Study Major Dates
Study Start
Primary Completion (Estimated)
Study Completion (Estimated)
Study Registration Dates
First Submitted
First Submitted That Met QC Criteria
First Posted (Actual)
Study Record Updates
Last Update Posted (Actual)
Last Update Submitted That Met QC Criteria
Last Verified
More Information
Terms related to this study
Additional Relevant MeSH Terms
Other Study ID Numbers
- 836211
Plan for Individual participant data (IPD)
Plan to Share Individual Participant Data (IPD)?
Drug and device information, study documents
Studies a U.S. FDA-regulated drug product
Studies a U.S. FDA-regulated device product
product manufactured in and exported from the U.S.
This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.
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