Dynamic imaging grade of swallowing toxicity (digest) in children with esophageal atresia


European Journal of Pediatric Surgery, 2023 (SCI-Expanded) identifier identifier

  • Publication Type: Article / Article
  • Publication Date: 2023
  • Doi Number: 10.1055/a-2181-2293
  • Journal Name: European Journal of Pediatric Surgery
  • Journal Indexes: Science Citation Index Expanded (SCI-EXPANDED), Scopus, Academic Search Premier, CAB Abstracts, CINAHL, EMBASE, MEDLINE, Veterinary Science Database
  • Hacettepe University Affiliated: Yes


Introduction: The Dynamic Imaging Grade of Swallowing Toxicity Scale (DIGEST) was developed to evaluate the safety, efficiency, and overall pharyngeal swallowing performance in patients with dysphagia. Although, various types of swallowing dysfunction are encountered in children with esophageal atresia (EA), oropharyngeal dysphagia poses risk for aspiration. Therefore, a retrospective study was performed to evaluate the safety and efficacy of swallowing by using DIGEST score in children with EA. Methods: Thirty-nine EA patients were included. The demographic features, respiratory problems, results and outcomes of surgical treatment were evaluated from medical records. The videofluoroscopic evaluation of swallowing (VFSE) investigated for both airway protection and bolus residuals at the level of vallecula, posterior pharyngeal wall and pyriform sinus at liquid and pudding consistencies. The penetration and aspiration scale (PAS) was used to define penetration and aspiration severity, and DIGEST was used to evaluate safety (DIGESTs), efficiency (DIGESTe), and overall pharyngeal swallowing performance (DIGESTt). Results: The median age of the patients were 13 months (7-39 months), and male to female ratio was 25:14. 67% of patients were type-C EA and 61% of them has associated anomalies. 38% of patients had aspiration (PAS= 6-8) in liquids and 10% in pudding consistency. Life threatening/profound swallowing dysfunction in DIGESTe (DIGEST=4) was seen in 13% (n=5) of patients. 40% of EA patients showed severe problems in DIGESTt. Conclusion: DIGEST is a valid and reliable tool to define the efficacy and safety of swallowing in children with EA.