Fiberoptic Endoscopic Evaluation of Swallowing

Abstract

Further research is needed to compare the efficacy and validity of FEES versus VFSS for infants in the NICU. Furthermore, evaluating the efficacy of FEES during breastfeeding is warranted.

European Society for Swallowing Disorders FEES Accreditation Program for Neurogenic and Geriatric Oropharyngeal Dysphagia

“…Among others, studies describing FEES in stroke and traumatic brain injury patients [ 16 – 18 ], patients with neurodegenerative (dementia, Parkinson’s disease) [ 9 , 19 , 20 ] and neuromuscular diseases (for example ALS, myasthenia gravis, myotonic dystrophy) [ 21 – 24 ] as well as head and neck cancers [ 25 – 27 ] have been published. FEES is also being increasingly applied in pediatrics [ 28 – 30 ], geriatrics, [ 31 , 32 ] and intensive-care medicine [ 33 , 34 ].…”

Simultaneous Videofluoroscopy and Endoscopy for Dysphagia Evaluation in Preterm Infants—A Pilot Study

“…Until recently, VFSS was the only available tool to study dysphagia in preterm infants (1,2). This procedure has several disadvantages (1,19), including the use of radiation, the inability for use during breastfeeding, and the requirement that the infant must be transported to a radiology suite (7), which can be risky for sick preterm infants. The introduction of FEES, with its various advantages over VFSS, set the stage for a new era in dysphagia diagnosis in preterm infants.…”

“…Once the infant was appropriately positioned, the FEES endoscopist passed the fiberscope trans-nasally and guided the scope through the nasal cavity into the pharynx for a high position ( 13 ) while the feeder stabilized the infants' head. No topical anesthesia or decongestant was used ( 3 , 7 ). During scope placement, the feeder kept the infant calm with a pacifier and, if required, using a 24% sucrose solution (Sweet-Ease Natural, Philips Mother and Child Care, Koninklijke Philips NV, USA) for 2 min prior to and during insertion.…”

“…The FEES procedure has several advantages over VFSS (7,8). The natural feeding environment is not altered with FEES, as it can be performed at the bedside within a more natural feeding environment/position, with the infants' routine feeding liquids as well as during breastfeeding.…”

“…However, the greatest advantages of FEES are the avoidance of radiation exposure, ease of use, low ongoing cost, the ability to observe the pharyngeal and laryngeal anatomy directly, evaluate pooling secretions in the pharynx/larynx, as well as the ability to repeat the procedure as frequently as indicated. However, FEES does have some limitations, as the laryngeal elevation during swallowing causes the epiglottis to invert, which can temporarily block the view during endoscopy (white-out period), as well as possible discomfort during endoscopy (3,7). The initial cost of equipment and training necessary to perform FEES is considerable.…”