Flexible Endoscopic Evaluation of Swallowing with Sensory Testing: Patient Characteristics and Analysis of Safety in 1,340 Consecutive Examinations

Abstract

Flexible endoscopic evaluation of swallowing with sensory testing (FEESST) is a comprehensive endoscopic assessment of the sensory and motor components of a swallow. Previous studies addressing patient safety issues with respect to FEESST included relatively small numbers of patients and paid almost no attention to patient characteristics. The purpose of this study was to determine the incidence of FEESST-related complications in the outpatient and inpatient settings and to analyze patient diagnoses that led to the performance of FEESST. We performed a prospective study of FEESST complications in 1,340 consecutive evaluations performed over a 4 1/2-year period. The primary outcome variables were incidence of epistaxis and airway compromise. The secondary outcome variable was underlying patient diagnoses. The incidence of epistaxis was 1 in 1,340 (0.07%). There were no instances of airway compromise. Stroke was the most common reason for the performance of FEESST (343; 25.6%), followed by cardiac-related dysphagia (298; 22.2%) following open heart surgery (169/298; 56.7%), heart attack, congestive heart failure, or new arrhythmia. The remaining causes were head and neck cancer (207; 15.4%), pulmonary disease (141; 10.5%), chronic neurologic disease (124; 9.3%), and acid reflux disease (80; 6.0%). We conclude that FEESST is a relatively safe procedure for the sensory and motor assessment of dysphagia in a cohort of patients with a wide variety of underlying diagnoses. The emergence of cardiac surgery as a common cause of dysphagia warrants further study.

The Safety of Fiberoptic Endoscopic Evaluation of Swallowing in Acute Stroke Patients

“…Despite this critical ill and medical instable study population, the amount of complications during FEES did not essentially differ from previous studies that enrolled less affected patients with a great variety of underlying diseases. 17,20,22 In the present study, there were no instances of airway comprise, decrease in the level of consciousness, laryngospasm, or epistaxis that required special treatment. Furthermore, no patient suffered from symptomatic brady-or tachycardia.…”

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

“…There are only a few published papers regarding the safety of FEES and endoscopic evaluation of swallowing with sensory testing (FEESST) [1,16,31,32,33,34,35,36]. Because of the scarcity of data concerning safety during investigations with FEES, a retrospective study of the side effects and complications in 2,820 consecutive evaluations was performed.…”

Avaliação clínica e objetiva da deglutição em crianças com paralisia cerebral

“…Comprometimentos em qualquer fase e/ou entre as fases da deglutição caracterizam as disfagias (2) , que, na infância, são frequentes nos casos de paralisia cerebral (PC), acarretando riscos de desnutrição, desidratação e infecções pulmonares (3) . Os métodos mais utilizados para a investigação das disfagias são a avaliação clínica fonoaudiológica (ACF) e os exames objetivos, como a avaliação videoendoscópica da deglutição (VED) (4)(5)(6) . Na ACF, realiza-se criteriosa história clínica com avaliação morfofuncional da deglutição, especialmente das fases preparatória oral e oral, visando prevenir e/ou reduzir os riscos à saúde (4) .…”

“…Na ACF, realiza-se criteriosa história clínica com avaliação morfofuncional da deglutição, especialmente das fases preparatória oral e oral, visando prevenir e/ou reduzir os riscos à saúde (4) . A VED consiste em uma nasofibrolaringoscopia tradicional, com o oferecimento de alimentos tingidos com corantes, possibilitando a investigação da fase faríngea da deglutição, a qual apresenta o caminho concomitante entre vias respiratória e digestiva superior (5,6) . Com apoio nos achados da ACF e VED, realizam-se adequações na dieta alimentar da criança com PC, como a escolha de volumes, consistências e manobras compensatórias apropriadas para a alimentação, no intuito de prevenir a ocorrência de manifestações disfágicas (6,7) .…”