Low-risk assessment of swallowing impairment using flexible endoscopy without food or liquid.

OBJECTIVES/HYPOTHESIS: Flexible endoscopic evaluation of swallowing (FEES) is a relatively safe procedure to determine the safety of oral feeding, and consists of the introduction of food and liquid as well as a sensitivity test. However, the introduction of food and liquid can cause pneumonia or suffocation secondary to aspiration. To solve this problem, we investigated the possibility of performing FEES without introduction of food or liquid (referred to hereafter as FEES screen) to assess swallowing impairment severity.

STUDY

DESIGN

Retrospective study.

METHODS

A total of 106 subjects with swallowing impairment underwent conventional FEES, and both their salivary pooling degree and larynx sensitivity were analyzed to detect swallowing impairment without the introduction of food or liquid. The subjects were divided into two groups: an undetectable swallowing impairment (USI) group and a detectable swallowing impairment (DSI) group. The general characteristics, functional impairment status, and clinical assistance requirements of the two groups were investigated and compared.

RESULTS

The numbers of subjects in the USI and DSI groups were 64 and 42, respectively. The DSI group showed a significantly higher prevalence of aspiration during FEES, and their required levels of care were also significantly higher. Additionally, their levels of consciousness, oral intake ability, and activities of daily living were significantly low compared to the USI group.

CONCLUSIONS

This study demonstrated the feasibility of FEES screen for assessment of swallowing impairment severity. Using our low-risk assessment, we were able to identify subjects with low oral intake ability as well as those who required intervention.

LEVEL OF EVIDENCE: 4 Laryngoscope, 129:2249-2252, 2019.