Static endoscopic evaluation of swallowing: Transoral endoscopy during clinical swallow evaluations

Abstract

Objective To determine the sensitivity and specificity for assessing pharyngeal residue, laryngeal penetration, and tracheal aspiration when comparing findings from the Static Endoscopic Evaluation of Swallowing (SEES) with findings from the Videofluoroscopic Swallow Study (VFSS). Review Methods Retrospective study at a tertiary academic medical center. Records were reviewed consecutive outpatients who underwent both SEES and VFSS evaluations. Video segments from SEES and VFSS examinations were blindly judged by experienced clinicians on a categorical/ordinal rating form for the absence, quantitative presence, and location of post-swallow residue, penetration, and aspiration. Statistical analysis was performed to identify intra- and inter-rater reliability and correlation between SEES and VFSS findings. Results Thirty-nine patients were identified who met the above inclusion criteria, for a total of 206 video segments. Inter and intra-rater reliability was judged by Cronbach’s Alpha to be good to excellent. SEES findings revealed statistically significant correlations with VFSS findings (p < 0.001) with the absence, quantitative presence, and location of thin liquid and solid swallow residue, penetration, and aspiration. In addition, SEES was more sensitive to the presence of liquid residue, penetration, and aspiration than VFSS. Conclusion The SEES is an endoscopic screening procedure that strengthens the clinical swallowing evaluation by documenting the presence or absence of post-swallow residue, penetration, and aspiration. Accurate identification of a patient’s risk for aspiration helps to direct further work-up. It is an expedient, repeatable, and clinical relevant procedure that can be easily incorporated into a clinician’s practice.

Accuracy of endoscopic and videofluoroscopic evaluations of swallowing for oropharyngeal dysphagia

“…Afterward, the aspirated food may be detected by an endoscope in the glottis, as recommended by the standard protocol of FEES . These results are consistent with those reported recently using a new test, the static endoscopic evaluation of swallowing (SEES), in which a rigid endoscopy is performed before and after swallowing to detect alterations in swallowing safety . SEES was found to be more sensitive than VFSS to aspiration, penetration, and residues, which leads to the conclusion that the difference between endoscopic and radiographic evaluations of swallowing is related to the fact that endoscopic tests have better image resolution and thus are easier to interpret.…”

“…These results are consistent with those reported recently using a new test, the static endoscopic evaluation of swallowing (SEES), in which a rigid endoscopy is performed before and after swallowing to detect alterations in swallowing safety . SEES was found to be more sensitive than VFSS to aspiration, penetration, and residues, which leads to the conclusion that the difference between endoscopic and radiographic evaluations of swallowing is related to the fact that endoscopic tests have better image resolution and thus are easier to interpret. Specifically, they produce an image from an axial endoscopic view with greater definition than the bidimensional shadows generated by the tissue penetration of x‐rays.…”

Static endoscopic swallow evaluation in children

“…The patient was allowed to swallow the bolus in a natural state, immediately prior to endoscope insertion. Rather than inserting a rigid endoscope transorally as described by Curtis et al, a distal‐chip flexible laryngoscope was passed via the nasal airway to visualize the hypopharynx and larynx to assess for the presence of pharyngeal residue, penetration, and aspiration following the swallow. All consistencies were colored with green food coloring.…”

“…In their 2016 report, Curtis and colleagues described the Static Endoscopic Evaluation of Swallowing (SEES), a means of supplementing the adult clinical swallow evaluation by assessing pharyngeal residue, penetration, and aspiration patterns both before and after—but not during—the swallow. They demonstrated a strong correlation between SEES and VFSS in adult patients, and a higher level of sensitivity for aspiration and penetration than VFSS . While SEES as it was initially described may not be directly and wholly applicable to the pediatric population, we perceived several potential unique benefits of a static swallow assessment in the pediatric arena, particularly in children who are unlikely to tolerate a formal FEES.…”

A brief history of topographical anatomy

“…(Stamm et al 2006). Applications were not exclusively clinical: endoscopic and videofluoroscopic evaluation of normal subjects has increased understanding of the anatomical bases of activities such as swallowing (Curtis et al 2015) and phonation.…”