Evaluation of Swallowing Safety With Fiberoptic Endoscope: Comparison With Videofluoroscopic Technique

Abstract

Videofluoroscopy has long been viewed as the "gold standard" of swallowing examination for the comprehensive information it provides. However, it is not very efficient and accessible in some practical situations. In this study, we tried to use a modified technique of fiberoptic endoscopic examination of swallowing (FEES) in evaluating dysphagic patients. For each examination, a spoonful of pudding and dyed water were fed in sequence three times. The pharyngeal swallowing events were observed with fiberscope panoramically and videotaped. Twenty-eight chronic dysphagic patients underwent both videofluoroscopy and FEES in 2 weeks. Comparison of the results revealed that disagreements in premature oral leakage to the pharynx, pharyngeal stasis, laryngeal penetration, aspiration, effective cough reflex, and velopharyngeal incompetence were 39.3%, 10.7%, 14.3%, 14.3%, 39.3%, and 32.1%, respectively. FEES was found to be more sensitive in detecting these risky features of swallowing, except with respect to premature leakage. Possible causes of the discrepant results are discussed, and the limitation of videofluoroscopy in practical usage is discussed. FEES is conclusively a safer, more efficient, and sensitive method than videofluoroscopy in evaluating swallowing safety.

Complications with Fiberoptic Endoscopic Evaluation of Swallowing in 2,820 Examinations

“…When doing this, it is possible (albeit rare) to encounter adverse events. These may include side effects such as discomfort, gagging and/or vomiting, and complications such as anterior epistaxis, posterior epistaxis, laceration of the mucosa, allergic reactions/hypersensitivity to topical anaesthesia or nasal spray, adverse reactions to methylene blue (contraindicated in favism), vasovagal response and laryngospasm [1,16,31,32,33,34,35]. Discomfort has been referred to as the most frequently reported adverse event; the use of topical anaesthesia may reduce the occurrence of this, though it may alter the swallowing mechanisms [33].…”

“…For several years now, and especially in the latest reports in the literature, it has been demonstrated that FEES can be better at determining penetration, aspiration and residue, therefore these two investigations should be considered complementary rather than competitors [12,16]. Other tests that are considered complementary for studying dysphagia are oro-pharyngo-oesophageal scintigraphy [17,18,19], ultrasound [20,21,22,23], pH manometry [24,25,26,27] and, most recently, high-resolution manometry [27,28,29,30].…”

“…There are only a few published papers regarding the safety of FEES and endoscopic evaluation of swallowing with sensory testing (FEESST) [1,16,31,32,33,34,35,36]. Because of the scarcity of data concerning safety during investigations with FEES, a retrospective study of the side effects and complications in 2,820 consecutive evaluations was performed.…”

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

“…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].…”

Botulismo e disfagia

“…With the improvement presented by the patient and with good results observed in such a short period of time, the medical team believed that the performance of an objective test for swallowing would be advantageous (Ott, 1998;Chih Hsiu et al, 1997;Hinds & Willes, 1998;Ertekin & Aydogdu, 2003) in order to prove the absence of any kind of alteration during swallowing. With this, new procedures could be established in order to guarantee success, given the rapid improvement.…”