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Safety and clinical impact of FEES – results of the FEES-registry

Published on Dec 1, 2019
· DOI :10.1186/s42466-019-0021-5
Rainer Dziewas1
Estimated H-index: 1
,
Matthias auf dem Brinke1
Estimated H-index: 1
+ 43 AuthorsTobias Warnecke24
Estimated H-index: 24
Abstract
At present, the flexible endoscopic evaluation of swallowing (FEES) is one of the most commonly used methods for the objective assessment of swallowing. This multicenter trial prospectively collected data on the safety of FEES and also assessed the impact of this procedure on clinical dysphagia management. Patients were recruited in 23 hospitals in Germany and Switzerland from September 2014 to May 2017. Patient characteristics, professional affiliation of the FEES examiners (physicians or speech and language therapists), side-effects and cardiorespiratory parameters, severity of dysphagia and clinical consequences of FEES were documented. 2401 patients, mean age 69.8 (14.6) years, 42.3% women, were included in the FEES-registry. The most common main diagnosis was stroke (61%), followed by Parkinson’s disease (6.5%). FEES was well tolerated by patients. Complications were reported in 2% of examinations, were all self-limited and resolved without sequelae and showed no correlation to the endoscopist’s previous experience. In more than 50% of investigations FEES led to changes of feeding strategies, in the majority of cases an upgrade of oral diet was possible. This study confirmed that FEES, even when performed by less experienced clinicians is a safe and well tolerated procedure and significantly impacts on the patients’ clinical course. Implementation of a FEES-service in different clinical settings may improve dysphagia care. ClinicalTrials.gov NCT03037762, registered January 31st 2017.
  • References (43)
  • Citations (1)
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References43
Newest
#1Thomas MarianH-Index: 4
#2Martin W. Dünser (Johannes Kepler University of Linz)H-Index: 9
Last. Rainer DziewasH-Index: 34
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6 CitationsSource
#1Christina Pflug (UHH: University of Hamburg)H-Index: 3
#2Moritz Bihler (UHH: University of Hamburg)H-Index: 2
Last. Carsten Buhmann (UHH: University of Hamburg)H-Index: 23
view all 11 authors...
To assess the prevalence of dysphagia and its typical findings in unselected “real-world” Parkinson patients using an objective gold-standard method. This was a prospective, controlled, cross-sectional study conducted in 119 consecutive Parkinson patients of all stages independent of subjective dysphagia. Patients and 32 controls were clinically and endoscopically examined by flexible endoscopic evaluation of swallowing (FEES) to evaluate the deglutition with regard to three consistencies (water...
19 CitationsSource
#1Rainer DziewasH-Index: 1
#2Laura W. J. Baijens (UM: Maastricht University)H-Index: 18
Last. Pere Clavé (Autonomous University of Barcelona)H-Index: 36
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The oropharyngeal swallow involves a rapid, highly coordinated set of neuromuscular actions beginning with lip closure and terminating with opening of the upper esophageal sphincter. The central coordination of this complex sensorimotor task uses a widespread network of cortical, subcortical, and brainstem structures. Many diseases and disorders affecting the central swallowing network or downstream peripheral nerves, muscles, and structures may result in an impaired oropharyngeal swallow, i.e.,...
4 CitationsSource
#1Sriramya Lapa (Goethe University Frankfurt)H-Index: 3
#2Sebastian Luger (Goethe University Frankfurt)H-Index: 7
Last. Christian Foerch (Goethe University Frankfurt)H-Index: 31
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Background and Purpose— Little is known about the frequency and the clinical characteristics of neurogenic dysphagia in pontine strokes. In this study, we sought to identify predictors for dysphagia in a cohort of patients with isolated pontine infarctions. Methods— We included all patients admitted to our department between 2008 and 2014 having an acute (<48 hours after symptom onset) ischemic stroke in the pons, as documented by means of diffusion-weighted magnetic resonance imaging. Precise i...
3 CitationsSource
#1Rainer DziewasH-Index: 34
#2Anne Marie Beck (Metropolitan University College)H-Index: 21
Last. Rainer Wirth (FAU: University of Erlangen-Nuremberg)H-Index: 20
view all 15 authors...
The oropharyngeal swallow involves a rapid, highly coordinated set of neuromuscular actions beginning with lip closure and terminating with opening of the upper esophageal sphincter. The central coordination of this complex sensorimotor task uses a widespread network of cortical, subcortical, and brainstem structures. Many diseases and disorders affecting the central swallowing network or downstream peripheral nerves, muscles, and structures may result in an impaired oropharyngeal swallow. In ad...
20 CitationsSource
#1Susan E. Langmore S E (BU: Boston University)H-Index: 33
24 CitationsSource
#1Rainer DziewasH-Index: 34
#2J. GlahnH-Index: 6
Last. Otto BusseH-Index: 20
view all 14 authors...
Background Neurogenic dysphagia is one of the most frequent and prognostically relevant neurological deficits in a variety of disorders, such as stroke, parkinsonism and advanced neuromuscular diseases. Flexible endoscopic evaluation of swallowing (FEES) is now probably the most frequently used tool for objective dysphagia assessment in Germany. It allows evaluation of the efficacy and safety of swallowing, determination of appropriate feeding strategies and assessment of the efficacy of differe...
11 CitationsSource
#1Steven B. Leder (Yale University)H-Index: 32
#2Debra M. Suiter (UK: University of Kentucky)H-Index: 3
Last. Leo M. Cooney (Yale University)H-Index: 26
view all 4 authors...
United States census data project dramatic increases in the geriatric population ageing demographics by 2060 with concomitant health-care consequences. The purpose of this replication and continuation study was to collect new 2014 demographic data relative to ageing, swallow evaluation referral rates, and oral feeding status in geriatric-hospitalized patients for comparison with published data from 2000 to 2007. This was a planned data acquisition study of consecutive hospitalized patients refer...
10 CitationsSource
#1Tobias WarneckeH-Index: 24
#2Inga SuttrupH-Index: 7
Last. Rainer DziewasH-Index: 34
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Abstract Background It is still controversially discussed whether central dopaminergic stimulation improves swallowing ability in Parkinson's disease (PD). We evaluated the effect of oral levodopa application on dysphagia in advanced PD patients with motor fluctuations. Methods In 15 PD patients (mean age 71.93 ± 8.29 years, mean disease duration 14.33 ± 5.94 years) with oropharyngeal dysphagia and motor fluctuations endoscopic swallowing evaluation was performed in the off state and on state co...
24 CitationsSource
#1Andrea NacciH-Index: 15
#2Jacopo MatteucciH-Index: 2
Last. Bruno FattoriH-Index: 19
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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 stu...
4 CitationsSource
Cited By1
Newest
#1Werner Hacke (Heidelberg University)H-Index: 114
Source
#1Paitoon Benjapornlert (MU: Mahidol University)
#2Hitoshi Kagaya (Fujita Health University)H-Index: 15
Last. Eiichi Saitoh (Fujita Health University)H-Index: 22
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BACKGROUND Swallowing disorder or dysphagia is quite common in hospitalized patients. Using Fiberoptic Endoscopic Evaluation of Swallowing (FEES) is one of the clinical standards for evaluating swallowing disorder to prevent serious consequences such as aspiration pneumonia. OBJECTIVES This study aimed to determine the prevalence and the associated risk of dysphagia in hospitalized patients by using FEES finding METHODS: We retrospectively analyzed the FEES records from the patients who were scr...
Source
#1Bendix Labeit (WWU: University of Münster)H-Index: 1
#2Inga ClausH-Index: 3
Last. Tobias WarneckeH-Index: 24
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Abstract Introduction The pathophysiology of dysphagia in Parkinson's disease (PD) is heterogeneous and poorly understood at present. This study investigated the phenotypes, prevalence and pathophysiology of oropharyngeal freezing (OPF) in PD and its relation to dysphagia. Methods In a prospective study, 50 PD patients were systematically screened for OPF using flexible endoscopic evaluation of swallowing (FEES). In addition, FEES-videos of 50 patients with post-stroke dysphagia and 50 healthy s...
Source
#1Bendix Labeit (WWU: University of Münster)H-Index: 1
#2Inga ClausH-Index: 3
Last. Tobias WarneckeH-Index: 24
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Background. Pharyngeal dysphagia is a common symptom of Parkinson’s disease (PD) leading to severe complications. PD-related pharyngeal dysphagia (PDrPD) may significantly improve in up to half of patients following acute oral levodopa challenge. Objective. The aim of this study was to investigate the effects of levodopa-carbidopa intestinal gel (LCIG) on PDrPD. Methods. Forty-five PD patients under LCIG treatment were available for retrospective analysis. In all patients with PDrPD who underwen...
Source
#1Peter E. Spronk (Gelre Hospitals)H-Index: 41
#2Laura E. J. Spronk (Gelre Hospitals)
Last. Anke Kröner (Gelre Hospitals)H-Index: 4
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BACKGROUND: Information on the prevalence of dysphagia in a generalized hospitalized population is lacking. We aimed to gain information on the recognition of dysphagia by nursing staff and the swallow characteristics of patients with and without dysphagia. METHODS: The Eating Assessment Tool (EAT-10) and the volume-viscosity water swallow test (VVST) were utilized to assess the prevalence of dysphagia in a generalized hospitalized population in 2 centers (N = 205). Presence of dysphagia was def...
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#1Tobias Braun (University of Giessen)H-Index: 1
#2Martin JuenemannH-Index: 5
Last. Christian TanislavH-Index: 15
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Diagnosing dysphagia in acute stroke patients is crucial, as this comorbidity determines morbidity and mortality; we therefore investigated the impact of flexible nasolaryngeal endoscopy (FEES) in acute stroke patients. The FEES investigation as performed in acute stroke patients treated at a large university hospital, allocated as a standard procedure for all patients suspected of dysphagia. We correlated our findings with baseline data, disability status, pneumonia, duration of hospitalisation...
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#1Bendix LabeitH-Index: 1
#2Paul MuhleH-Index: 7
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BACKGROUND: Intact pharyngeal sensation is essential for a physiological swallowing process, and conversely, pharyngeal hypesthesia can cause dysphagia. This study introduces and validates a diagnostic test to quantify pharyngeal hypesthesia. METHODS: A total of 20 healthy volunteers were included in a prospective study. Flexible endoscopic evaluation of swallowing (FEES) and a sensory test were performed both before and after pharyngeal local anesthesia. To test pharyngeal sensation, a small tu...
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