Contrast Swallow for Detecting Pharyngocutaneous Fistula After Total Laryngectomy: A Systematic Review

To evaluate the diagnostic performance of contrast swallow utilised to identify pharyngocutaneous fistula (PCF) following laryngectomy.

A systematic search of databases was conducted (MEDLINE, EMBASE, and PubMed).

Studies including adult patients (≥18 years old) who had undergone total laryngectomy (salvage or primary) or pharyngolaryngectomy and had postoperative diagnostic imaging of any modality (eg, ultrasound, CT, MRI) performed to assess for presence of PCF were eligible for inclusion. The diagnostic accuracy (ie sensitivity, specificity, etc.) for identifying PCF was extracted.

A total of 13 studies involving 1456 patients recruited across a 43-year period from (1979 to 2022) were included. Diagnostic accuracy ranges of contrast swallow were reported as a sensitivity of 0.26 to 1.00, specificity of 0.55 to 0.99 and positive and negative predictive values of 0.14 to 0.85 and 0.75 to 1.00 respectively.

The accuracy of contrast swallow as a screening tool in detecting PCF varies significantly in the reported studies with overall poor performance. Studies displayed a varied positive predictive value range, with a high number of false positives potentially causing unwarranted delays in commencing oral feeding. Positive predictive values must be interpreted cautiously given the literatures variation of how pharyngeal leaks were managed, potentially preventing progression to clinical PCF. While the heterogenicity within the data from the studies prevents definitive conclusions, the review calls into question the utility of the contrast swallow and highlights the need for more superior diagnostic pathways.