Tracheoesophageal diversion improves oral uptake of food: a retrospective study

Purpose: Tracheoesophageal diversion (TED) is an effective therapeutic procedure for intractable aspiration. In this study, we performed TED in cases of intractable aspiration and/or repetitive pneumonia, investigated the main route of nutritional uptake after the procedure, and evaluated the swallowing method using videofluoroscopy. We also evaluated the validity of TED for treating intractable aspiration. Methods: We retrospectively reviewed 44 patients (30 male and 14 female patients; median age, 55 years; range 15–85 years) who underwent TED for the treatment of intractable aspiration between January 2008 and December 2017. We examined the route of nutritional uptake before and after the operation and performed videofluoroscopy to detect the swallowing method after the operation. Results: The percentage of patients with oral intake increased from 21% (9/44) before TED to 56% (25/44) within 1 month after TED (p < 0.01); this percentage included patients with poor preoperative swallowing function. Overall, 60% patients who were able to communicate and mobilize using a wheelchair as well as 92% patients who were able to communicate and mobilize in the supine position were able to consume food orally. We subsequently performed videofluoroscopy in 24 of the 25 patients with oral intake and assessed the passage route of the contrast agent, which was found to move through the laryngeal route in 54% of these patients. Conclusion: TED may be suitable for the treatment of intractable aspiration and can improve oral intake, particularly in patients with good mobility and communication ability.