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

Abstract

Objective: To perform a retrospective evaluation of the incidence of complications and adverse events during fiberoptic endoscopic evaluation of swallowing (FEES) in 2,820 examinations. Patients and Methods: Subjects included in- and outpatients at Pisa University Hospital referred for FEES by other physicians due to dysphagia symptoms. Neurologic diseases were the most commonly diagnosed conditions in the patients tested (48.3%). Informed consent was obtained from all subjects. Results: Our study showed minor side effects (discomfort, occasional gagging and vomiting) and a few complications [three cases of anterior epistaxis (0.1%), one case of posterior epistaxis (0.04%), three cases of vasovagal syncope (0.1%) and two cases of laryngospasm (0.07%)]. These cases of laryngospasm occurred in patients with amyotrophic lateral sclerosis (ALS) and spontaneously resolved after some difficulty. Conclusions: Our study confirms the published data regarding the safety of FEES and the incidence of complications with this procedure, but also highlights that in neurologic patients with neurodegenerative diseases such as ALS, laryngospasm is more likely to occur as a severe complication. The overall risk of FEES is minimal, but it is recommended that clinicians be well trained in recognising the signs and symptoms of adverse reactions and be ready to take appropriate action if these occur.

Fiberoptic Endoscopic Evaluation of Swallowing as possible index of ALS clinical development

“…It is necessary to remember that potential complications and adverse effects of FEES are very few. In one of our previous studies, we found significant complications such as posterior epistaxis in one patient (0.04%) and laryngospasm only in two patients (0.07%) out of 2,820 patients 1 . Moreover, its repeatability makes FEES especially suitable for the follow-up of dysphagic patients, in particular for patients suffering from Amyotrophic Lateral Sclerosis (ALS) [2][3][4] .…”

“…It is easy to perform, well tolerated, not requiring exposure to radiation, suitable for bedside examination, inexpensive, and with rare side-effects 1 . It is necessary to remember that potential complications and adverse effects of FEES are very few.…”

Fiberoptic endoscopic evaluation of the swallowing in neurogenic dysphagia: A proposal of an algorithm for fiberoptic endoscopic evaluation of the swallowing in neurology hospitals in Mexico

“…FEES is a safe procedure with few and rare complications such as epistaxis and transient bradycardia 24 . Nacci et al evaluated the safety of the FEES method and described an incidence of laryngospasm of 0.07%, related to the presence of neuromuscular diseases 25 . FEES seems to be a safe method for the assessing the swallowing function even in acute stroke patients 26 .…”

Effect of He’s Santong Needling Method on Dysphagia after Stroke: A Study Protocol for a Prospective Randomized Controlled Pilot Trial

“…Furthermore, VFSS cannot be used at the bedside frequently for follow-up tests because of the necessary exposure to radiation [ 37 ]. Compared with VFSS, the FEES is a more appropriate assessment tool for dysphagia assessment after stroke, especially for our study which concerns oral and pharyngeal phase of swallowing [ 38 , 39 ]. For stroke patients, a bedside test will ensure patient's comfort and compliance.…”