Endoscopic and Videofluoroscopic Evaluations of Swallowing and Aspiration

Langmore, Susan E.; Schatz, Klaus; Olson, Nels R.

doi:10.1177/000348949110000815

Cited by 407 publications

(60 citation statements)

References 12 publications

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“…In this study, we used the FEES method because it provides easy visualization of the pharyngeal phase of swallowing 11,12 in agreement with videofluoroscopy findings. It is known that the oral phase in HD can become poor and compromise the oral transit time.…”

Section: Discussionmentioning

confidence: 79%

Swallowing endoscopy findings in Huntington's disease: a case report

Alves

Cola

Santos

et al. 2016

CoDAS

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Huntington's disease (HD) is a degenerative genetic disorder with autosomal-dominant transmission. The triad of symptoms of this disease consists of psychiatric disorders, jerky movements, and dementia. Oropharyngeal dysphagia, which is more evident with disease progression, is also present. Few studies have addressed the swallowing characteristics using objective analysis in this population. The purpose of this research was to describe the swallowing endoscopic findings of the pharyngeal phase in HD. This is a cross-sectional study addressing a clinical case which included two individuals of the same family, male, 32 and 63 years old, designated as individual A and individual B, with progression of the disease for five and 13 years, respectively. Consistent liquid, nectar, and puree were offered during the evaluation. There was presence of posterior oral spillage in liquid and nectar, small amount of pharyngeal residues, and no laryngeal penetration or aspiration in the individuals with HD in this study. CoDAS 2016;28(4):486-488Huntington's disease and swallowing 487

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Section: Discussionmentioning

confidence: 79%

Swallowing endoscopy findings in Huntington's disease: a case report

Alves

Cola

Santos

et al. 2016

CoDAS

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“…On the contrary, critical management decisions regarding dietary alterations, degrees of oral intake, and institution of artificial feeding often depend on the videofluorographic assessment of aspiration [23]. Several studies have shown that the diagnostic precision in identifying aspiration is the same for FESS and VF [24]. Although in the Japanese guidelines of the VF swallowing examination it is determined to use barium sulfate [19], a large amount of aspiration of high-density barium sulfate is potentially life-threatening [25,26].…”

Section: Discussionmentioning

confidence: 99%

Water-Swallowing Test: Screening for Aspiration in Stroke Patients

2013

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Background and Purpose: The water-swallowing test (WST) is frequently used in clinical practice as a functional assessment to detect aspiration and prevent pneumonia. It is a standardized test used all over the world, but the amount of water given varies depending on the examiner. Furthermore, there are very few reports on the simultaneous performance of the WST and videofluorography (VF). This study compared the amount of swallowed water to investigate the reliability of WST to exclude aspiration following acute stroke. Methods: We assessed 111 stroke patients (65 men and 46 women) with suspected dysphagia/difficulty in swallowing and performed VF upon obtaining consent from the patients and their families. Patients were aged between 20 and 98 years (65.6 ± 13.4 years); 64 had cerebral infarction, 26 cerebral hemorrhage, 13 subarachnoid hemorrhage, and 8 had other cerebrovascular disease. The time from stroke onset to VF was 16.6 ± 10.3 days (range, 2-55). WSTs using 5, 10, 30, and 60 ml and the modified WST (MWST) were performed during VF. Results: We found that the number of instances of choking, cough, wet voice, and aspiration increased with higher amounts of water. The sensitivity and specificity of WST for aspiration ranged from 34.8 to 55.7% and from 78.9 to 93.2%, respectively. The MWST, which used only 3 ml of water, yielded a sensitivity of 55.3% and a specificity of 80.8% for aspiration. There was a positive correlation between the time for one swallow and age, but there was no difference between genders. There was also no connection between clinical findings during WST or the presence of aspiration with the number of swallows, swallowing speed, or time for one swallow. Conclusions: WSTs are not as powerful as VF as a screening instrument in acute stroke. WSTs with more water detected aspiration with greater sensitivity, but there is no justification for overconfidence when investigating aspiration. We recommend using WST as well as VF to investigate swallowing in stroke patients.

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“…Patients were examined within 72 h after stroke onset. The standard FEES protocol was followed [23, 28] with slight modifications. In brief, patients were evaluated at bedside in the local stroke unit with the upper part of the body being elevated.…”

Section: Methodsmentioning

confidence: 99%

“…Fiberoptic endoscopic evaluation of swallowing (FEES), on the other hand, is generally well tolerated and therefore frequently repeatable [20]. FEES can be performed at the bedside like a usual clinical examination, and has a similar sensitivity and specificity for detecting signs of dysphagia, especially silent aspiration, to videofluoroscopy [21,22,23,24]. Reports indicate that FEES has the potential to significantly improve regular swallowing assessment in acute stroke care [25].…”

Section: Introductionmentioning

confidence: 99%

Towards a Basic Endoscopic Assessment of Swallowing in Acute Stroke – Development and Evaluation of a Simple Dysphagia Score

Dziewas¹,

Warnecke²,

Ölenberg³

et al. 2008

Cerebrovasc Dis

155

115

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Background and Purpose: Dysphagia is an important complication of acute stroke with a reported incidence of up to 76%. The purpose of this investigation was to develop and to evaluate an endoscopic scoring system which has the potential to guide dysphagia management in acute stroke patients. Methods: A fiberoptic endoscopic evaluation of swallowing (FEES) was carried out in 100 patients within 72 h of stroke onset. During endoscopic examination, the secretion status was evaluated, and the patient was successively given standard volumes of puree consistency, liquids and soft solid food. Penetration and aspiration was assessed using a 5-point scale. Results: Nearly 80% of patients showed penetration or aspiration during FEES. These events occurred more frequently with liquids and soft solid food than with puree. Penetration or aspiration at any stage of examination predicted failure at the subsequent food consistency. Furthermore, key findings of endoscopic evaluation were predictive of the need for later orotracheal intubation. Based on these observations a score was developed that grades stroke-related dysphagia according to the risk of penetration or aspiration of the different food consistencies tested. Assessment of interrater reliability by means of 25 additional endoscopic examinations resulted in excellent agreement between three investigators, reflected by a ĸ coefficient of 0.89. Conclusion: Stroke-related dysphagia may effectively be graded using a simple endoscopic scoring system. The usefulness of this screening protocol with respect to patient outcome and intercurrent complications has to be studied in prospective clinical trials.

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Endoscopic and Videofluoroscopic Evaluations of Swallowing and Aspiration

Cited by 407 publications

References 12 publications

Swallowing endoscopy findings in Huntington's disease: a case report

Swallowing endoscopy findings in Huntington's disease: a case report

Water-Swallowing Test: Screening for Aspiration in Stroke Patients

Towards a Basic Endoscopic Assessment of Swallowing in Acute Stroke – Development and Evaluation of a Simple Dysphagia Score

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