Comparison of Simultaneous Swallowing Endoscopy and Videofluoroscopy in Neurogenic Dysphagia

Abstract

Objective: In the evaluation of oropharyngeal dysphagia, instrumental procedures, for example, flexible endoscopic evaluation of swallowing or videofluoroscopic swallowing study, are essential to improve diagnostic accuracy for salient findings such as penetration, aspiration, or pharyngeal residue. To date, it is unclear which of the 2 methods represents the diagnostic gold standard. The aim of this study, therefore, was to compare videofluoroscopy and swallowing endoscopy during a simultaneous swallowing examination in a large cohort of patients with oropharyngeal dysphagia. Designs: Prospective observational study. Setting and participants: In this study, 49 patients with oropharyngeal dysphagia (mean age 70.0 AE 10.8 years) were evaluated using simultaneous swallowing endoscopy and videofluoroscopy. Furthermore, the effect of narrow-band imaging in swallowing endoscopy on the assessment of penetration and aspiration was investigated in a subgroup of 19 patients. Measures: The Penetration-Aspiration Scale and the Yale Pharyngeal Residue Severity Rating Scale were rated independently based on both modalities. Results: Both modalities showed a high correlation between penetration, aspiration, and pharyngeal residue. Causes for a higher score on the Penetration-Aspiration Scale in videofluoroscopy were intradeglutitive events that were not visible in swallowing endoscopy or false-positive events because of the loss of the lateral dimension in videofluoroscopy. A typical reason for a higher score on this scale in swallowing endoscopy was the better visualization of the anatomical structures. Narrow-band imaging in swallowing endoscopy resulted in a higher score on the Penetration-Aspiration Scale for liquids and semisolids in individual cases, although overall there was no statistically significant difference between scores using white light or narrow-band imaging. Conclusions and Implications: Videofluoroscopy and swallowing endoscopy may equally be considered as a diagnostic gold standard for oropharyngeal dysphagia regarding penetration, aspiration, and pharyngeal residue. Narrow-band imaging may increase the sensitivity for penetration and aspiration in individual cases.

Clinical determinants and neural correlates of presbyphagia in community-dwelling older adults

“…All participants underwent flexible endoscopic evaluation of swallowing (FEES), which, along with videofluoroscopy, is considered the diagnostic gold standard for dysphagia ( Labeit et al, 2021a ). FEES was performed following a stepwise protocol with testing of 3 different consistencies in the following order: three trials of 8 ml of green jelly (semisolid), three trials of 5 ml blue-dyed liquid, and 3 trials of white bread (solid) with a size of approximately 3 cm × 3 cm × 0.5 cm.…”

Hemodynamic signal changes and swallowing improvement of repetitive transcranial magnetic stimulation on stroke patients with dysphagia: A randomized controlled study

“…This scale is a semi-quantitative assessment of penetration and aspiration that is commonly used in endoscopic and radiological measurements. The higher the PAS score, the more impaired the swallowing function ( 39 ).…”

Assessment and treatment of neurogenic dysphagia in stroke and Parkinson's disease

“…FEES and VFSS represent gold-standard diagnostic approaches for oropharyngeal dysphagia, with similar high sensitivity and specificity to detect pharyngeal residue, penetration, and aspiration [34,35 ▪▪ ]. Accordingly, these investigations enable the quantification of dysphagia severity through rating scales, in particular the Penetration-Aspiration Scale (PAS) [36], the Dysphagia Outcome and Severity Scale [37], and the Yale Pharyngeal Residue Rating Scale [38].…”