Narrow Band Imaging Enhances the Detection Rate of Penetration and Aspiration in FEES

Abstract

Narrow band imaging (NBI) is widely used in gastrointestinal, laryngeal, and urological endoscopy. Its original purpose was to visualize vessels and epithelial irregularities. Based on our observation that adding NBI to common white light (WL) improves the contrast of the test bolus in fiberoptic endoscopic evaluation of swallowing (FEES), we now investigated the potential value of NBI in swallowing disorders. 148 FEES images were analyzed from 74 consecutive patients with swallowing disorders, including 74 with and 74 without NBI. All images were evaluated by four dysphagia specialists. Findings were classified according to Rosenbek's penetration-aspiration scale modified for evaluating these FEES images. Intra- and inter-rater reliability was determined as well as observer confidence. A better visualization of the bolus is the main advantage of NBI in FEES. This generally leads to sharper optical contrasts and better detection of small bolus quantities. Accordingly, NBI enhances the detection rate of penetration and aspiration. On average, identification of laryngeal penetration increased from 40 to 73% and of aspiration from 13 to 24% (each p < 0.01) of patients. In contrast to WL alone, the use of NBI also markedly increased the inter- and intra-rater reliability (p < 0.01) and the rating confidence of all experts (p < 0.05). NBI is an easy and cost-effective tool simplifying dysphagia evaluation and shortening FEES evaluation time. It leads to a markedly higher detection rate of pathological findings. The significantly better intra- and inter-rater reliability argues further for a better overall reproducibly of FEES interpretation.

Comparison of Simultaneous Swallowing Endoscopy and Videofluoroscopy in Neurogenic Dysphagia

“…This fits with a study on 74 patients in which narrow-band imaging in liquid and thickened liquid elicited more and more severe penetrations and aspirations compared with normal white light. 17 However, contrary to this previous study, overall, no statistically significant differences were obtained between narrow-band imaging and the normal light mode. Both the results with narrow-band imaging and with white light showed comparable correlation values with the videofluoroscopy results.…”

“…This is reported to increase vessel-mucosa contrast and thus enhance diagnostic sensitivity for penetrations and aspirations. 17 Nowadays, it is acknowledged that both swallowing endoscopy and videofluoroscopy are considered complementary, 12,13 and there are several expert reports comparing both instrumental methods considering their methodologic advantages and limitations. 18e20 However, aside from theoretical considerations, there are few studies comparing the diagnostic accuracy of the 2 modalities, 21 and only a handful have conducted simultaneous examinations that directly compare identical swallow trials.…”

High-sensitivity FEES® with the professional image enhancement technology “PIET”

“…This facilitates the FEES ® procedure. Besides the one-time investment of a "chip on the tip" videoscope with image enhancement, no further equipment is necessary to use with this method [3,5,7,9,12,13].…”

“…This technique is used to analyze and evaluate pathological epithelial changes [2][3][4]. Employing the NBI technique in a flexible endoscopic evaluation of swallowing (FEES ® ) allows a better detection of penetration and aspiration [5]. Especially, aspiration with a score of 8 on the penetration aspiration scale (PAS) according to Rosenbek [6] where parts of the bolus pass under the vocal folds into the trachea and might be overlooked.…”

Phoniatricians and otorhinolaryngologists approaching oropharyngeal dysphagia: an update on FEES

“…After the first description of in vivo assessment of the larynx by the singer and teacher Manuel Garcia in 1855 [ 9 ], experts in otorhinolaryngology and phoniatrics significantly contributed to the development of endoscopic techniques [ 10 , 11 ], and immediately took advantage of the introduction of flexible endoscopes for the assessment of the upper aerodigestive tract [ 12 , 13 ], first described in 1968 [ 14 ]. After the first report of fiberscope application for swallowing assessment by the SLP Susan Langmore in 1988 [ 1 ], phoniatricians and otorhinolaryngologists used this new technique for their patients’ OD management and further refined it with the help of various technological innovations [ 15 – 18 ].…”