Experience with the chin tuck maneuver in postesophagectomy aspirators

Aspiration is a common finding in the postesophagectomy barium swallow that often necessitates premature termination of the study prior to complete evaluation of the gastric conduit. More importantly, aspiration may play a significant role in the high incidence of postoperative pulmonary complications in this population. The chin tuck maneuver is a postural technique that reduces and often eliminates aspiration in swallowing-impaired patients. To evaluate the ability of the chin tuck maneuver to prevent aspiration during radiographic examination of the gastric conduit, the technique was used in 21 esophagectomy patients who aspirated during a swallowing evaluation combining the barium swallow and videofluoroscopy. Aspiration was eliminated in 81% of aspirators using the chin tuck maneuver. The results of this study demonstrate that the chin tuck maneuver is a simple technique that should be attempted in patients who aspirate postesophagectomy during radiographic imaging studies that require multiple swallows of contrast materials. Combining the barium swallow with the videofluoroscopic evaluation of swallowing provides objective documentation of both the structural integrity of the gastric conduit and swallowing function in patients after esophagectomies who are at high risk for postoperative morbidity.