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Adding Endoscopist-Directed Flexible Endoscopic Evaluation of Swallowing to the Videofluoroscopic Swallowing Study Increased the Detection Rates of Penetration, Aspiration, and Pharyngeal Residue.

Park WY, Lee TH, Ham NS, Park JW, Lee YG, Cho SJ, Lee JS, Hong SJ, Jeon SR, Kim HG, Cho JY, Kim JO, Cho JH, Lee JS - Gut Liver (2015)

Bottom Line: Currently, the videofluoroscopic swallowing study (VFSS) is the standard tool for evaluating dysphagia.Fifty consecutive patients suspected of oropharyngeal dysphagia were enrolled in this study between January 2012 and July 2012.No severe adverse events were noted during FEES, except for two cases of epistaxis, which stopped spontaneously without requiring any packing.

View Article: PubMed Central - PubMed

Affiliation: Institute for Digestive Research, Digestive Disease Center, Soonchunhyang University College of Medicine, Seoul, Korea.

ABSTRACT

Background/aims: Currently, the videofluoroscopic swallowing study (VFSS) is the standard tool for evaluating dysphagia. We evaluated whether the addition of endoscopist-directed flexible endoscopic evaluation of swallowing (FEES) to VFSS could improve the detection rates of penetration, aspiration, and pharyngeal residue, compared the diagnostic efficacy between VFSS and endoscopist-directed FEES and assessed the adverse events of the FEES.

Methods: In single tertiary referral center, a retrospective analysis of prospectively collected data was conducted. Fifty consecutive patients suspected of oropharyngeal dysphagia were enrolled in this study between January 2012 and July 2012.

Results: The agreement in the detection of penetration and aspiration between VFSS and FEES of viscous food (κ=0.34; 95% confidence interval [CI], 0.15 to 0.53) and liquid food (κ=0.22; 95% CI, 0.02 to 0.42) was "fair." The agreement in the detection of pharyngeal residue between the two tests was "substantial" with viscous food (κ=0.63; 95% CI, 0.41 to 0.94) and "fair" with liquid food (κ=0.37; 95% CI, 0.10 to 0.63). Adding FEES to VFSS significantly increased the detection rates of penetration, aspiration, and pharyngeal residue. No severe adverse events were noted during FEES, except for two cases of epistaxis, which stopped spontaneously without requiring any packing.

Conclusions: This study demonstrated that the addition of endoscopist-directed FEES to VFSS increased the detection rates of penetration, aspiration, and pharyngeal residue.

No MeSH data available.


Related in: MedlinePlus

Penetration, aspiration, and pharyngeal residue detected on endoscopist-directed flexible endoscopic evaluation of swallowing. (A) Penetration was defined when food material entered the laryngeal vestibule but did not pass below the true vocal cords. (B) Aspiration was defined as food material entering the airway below the true vocal cords. (C) Pharyngeal residue was defined as retention of >15% of a given entire material in valleculae or the pyriform sinuses.
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f1-gnl-09-623: Penetration, aspiration, and pharyngeal residue detected on endoscopist-directed flexible endoscopic evaluation of swallowing. (A) Penetration was defined when food material entered the laryngeal vestibule but did not pass below the true vocal cords. (B) Aspiration was defined as food material entering the airway below the true vocal cords. (C) Pharyngeal residue was defined as retention of >15% of a given entire material in valleculae or the pyriform sinuses.

Mentions: The endoscope was inserted through the nostril and placed between the end of the soft palate and the epiglottis. The patient was then allowed a 1-minute rest period to adapt to the presence of the laryngoscope and prepare for testing. The examination consisted of anatomic-physiologic assessment (including velar and laryngopharyngeal anatomy, movement, and sensation) and direct examination of swallowing test diets. When clinically indicated, an entire anatomic assessment of esophagus and stomach was performed. For the FEES test diets, we first used a 5-mL yogurt for viscous food followed by 5-mL indigocarmine dye-mixed water for liquid food (for ease of visualization as part of the FEES protocol adopted in the hospital). To minimize the possibility of aspiration during FEES, patients who had a compromised ability to swallow their own saliva and aspiration during viscous food swallowing were not given liquid food. The entire clinical procedure was recorded on video, and the videotape of the procedure was analyzed by the endoscopist (T.H.L.). The FEES measures included penetration, aspiration, and pharyngeal residue. Eight-point PAS was documented in all subjects. To facilitate statistical analysis, we reconstructed the scale and redefined level 1 as normal, levels 2–5 as penetration (food material entered into the laryngeal vestibule but not below the true vocal cord) (Fig. 1A), and levels 6–8 as aspiration (food material entered the airway below the true vocal cord) (Fig. 1B). Pharyngeal residue was defined as retention of the entire given material in the valleculae or pyriform sinuses after the swallow. However, double swallows are common in normal subjects, as well as in OPD patients. A previous study suggested that a small amount of residue, estimated at no more than 10% to 15% of the entire bolus, after first swallow should be considered a normal finding.15 Therefore, we defined pharyngeal residue in valleculae or pyriform sinuses as follows (Fig. 1C): (1) medium to large amount of residue after first swallow; (2) small amount of residue even after a double swallow.


Adding Endoscopist-Directed Flexible Endoscopic Evaluation of Swallowing to the Videofluoroscopic Swallowing Study Increased the Detection Rates of Penetration, Aspiration, and Pharyngeal Residue.

Park WY, Lee TH, Ham NS, Park JW, Lee YG, Cho SJ, Lee JS, Hong SJ, Jeon SR, Kim HG, Cho JY, Kim JO, Cho JH, Lee JS - Gut Liver (2015)

Penetration, aspiration, and pharyngeal residue detected on endoscopist-directed flexible endoscopic evaluation of swallowing. (A) Penetration was defined when food material entered the laryngeal vestibule but did not pass below the true vocal cords. (B) Aspiration was defined as food material entering the airway below the true vocal cords. (C) Pharyngeal residue was defined as retention of >15% of a given entire material in valleculae or the pyriform sinuses.
© Copyright Policy
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4562779&req=5

f1-gnl-09-623: Penetration, aspiration, and pharyngeal residue detected on endoscopist-directed flexible endoscopic evaluation of swallowing. (A) Penetration was defined when food material entered the laryngeal vestibule but did not pass below the true vocal cords. (B) Aspiration was defined as food material entering the airway below the true vocal cords. (C) Pharyngeal residue was defined as retention of >15% of a given entire material in valleculae or the pyriform sinuses.
Mentions: The endoscope was inserted through the nostril and placed between the end of the soft palate and the epiglottis. The patient was then allowed a 1-minute rest period to adapt to the presence of the laryngoscope and prepare for testing. The examination consisted of anatomic-physiologic assessment (including velar and laryngopharyngeal anatomy, movement, and sensation) and direct examination of swallowing test diets. When clinically indicated, an entire anatomic assessment of esophagus and stomach was performed. For the FEES test diets, we first used a 5-mL yogurt for viscous food followed by 5-mL indigocarmine dye-mixed water for liquid food (for ease of visualization as part of the FEES protocol adopted in the hospital). To minimize the possibility of aspiration during FEES, patients who had a compromised ability to swallow their own saliva and aspiration during viscous food swallowing were not given liquid food. The entire clinical procedure was recorded on video, and the videotape of the procedure was analyzed by the endoscopist (T.H.L.). The FEES measures included penetration, aspiration, and pharyngeal residue. Eight-point PAS was documented in all subjects. To facilitate statistical analysis, we reconstructed the scale and redefined level 1 as normal, levels 2–5 as penetration (food material entered into the laryngeal vestibule but not below the true vocal cord) (Fig. 1A), and levels 6–8 as aspiration (food material entered the airway below the true vocal cord) (Fig. 1B). Pharyngeal residue was defined as retention of the entire given material in the valleculae or pyriform sinuses after the swallow. However, double swallows are common in normal subjects, as well as in OPD patients. A previous study suggested that a small amount of residue, estimated at no more than 10% to 15% of the entire bolus, after first swallow should be considered a normal finding.15 Therefore, we defined pharyngeal residue in valleculae or pyriform sinuses as follows (Fig. 1C): (1) medium to large amount of residue after first swallow; (2) small amount of residue even after a double swallow.

Bottom Line: Currently, the videofluoroscopic swallowing study (VFSS) is the standard tool for evaluating dysphagia.Fifty consecutive patients suspected of oropharyngeal dysphagia were enrolled in this study between January 2012 and July 2012.No severe adverse events were noted during FEES, except for two cases of epistaxis, which stopped spontaneously without requiring any packing.

View Article: PubMed Central - PubMed

Affiliation: Institute for Digestive Research, Digestive Disease Center, Soonchunhyang University College of Medicine, Seoul, Korea.

ABSTRACT

Background/aims: Currently, the videofluoroscopic swallowing study (VFSS) is the standard tool for evaluating dysphagia. We evaluated whether the addition of endoscopist-directed flexible endoscopic evaluation of swallowing (FEES) to VFSS could improve the detection rates of penetration, aspiration, and pharyngeal residue, compared the diagnostic efficacy between VFSS and endoscopist-directed FEES and assessed the adverse events of the FEES.

Methods: In single tertiary referral center, a retrospective analysis of prospectively collected data was conducted. Fifty consecutive patients suspected of oropharyngeal dysphagia were enrolled in this study between January 2012 and July 2012.

Results: The agreement in the detection of penetration and aspiration between VFSS and FEES of viscous food (κ=0.34; 95% confidence interval [CI], 0.15 to 0.53) and liquid food (κ=0.22; 95% CI, 0.02 to 0.42) was "fair." The agreement in the detection of pharyngeal residue between the two tests was "substantial" with viscous food (κ=0.63; 95% CI, 0.41 to 0.94) and "fair" with liquid food (κ=0.37; 95% CI, 0.10 to 0.63). Adding FEES to VFSS significantly increased the detection rates of penetration, aspiration, and pharyngeal residue. No severe adverse events were noted during FEES, except for two cases of epistaxis, which stopped spontaneously without requiring any packing.

Conclusions: This study demonstrated that the addition of endoscopist-directed FEES to VFSS increased the detection rates of penetration, aspiration, and pharyngeal residue.

No MeSH data available.


Related in: MedlinePlus