Serial fiberoptic endoscopic swallowing evaluations in the management of patients with dysphagia.
OBJECTIVE
To determine whether serial fiberoptic endoscopic evaluation of swallowing (FEES) can be used successfully and efficiently in deciding to change a patient's feeding status from nonoral (NPO) to oral (PO) with no adverse health outcome.


METHODS
A prospective, consecutive, cohort study.


METHODS
Inpatient population of a tertiary-care university teaching hospital.


METHODS
Thirty-two adults were recruited from a cohort of 400 consecutive subjects who participated in a previous dysphagia study.


METHODS
Serial FEES was performed 3 to 6 times in each subject to detect objectively pharyngeal phase dysphagia, aspiration, and aspiration risk and to provide information for recommendations regarding oral feeding status and therapeutic intervention. The number of FEES was based on the subject's medical status, evidence of dysphagia, and clinical judgement.


METHODS
Identification of pharyngeal phase dysphagia, aspiration, and aspiration risk, and recommendations for initial feeding status, when to resume oral feeding, and what bolus consistencies to use for optimal swallowing success.


RESULTS
In all subjects, serial FEES detected pharyngeal phase dysphagia, aspiration, and aspiration risk and enabled determination of initial feeding status (NPO or PO), when to resume successful oral feeding, and what bolus consistencies to use for optimal swallowing success. Specifically, 15 of 32 (47%) subjects received FEES 3 to 5 times within only 6 to 22 days. Timely serial FEES allowed 22 of 32 (69%) subjects to resume an oral diet as early and safely as possible.


CONCLUSIONS
No subject who resumed an oral diet based on results of FEES developed an aspiration pneumonia. Serial FEES, therefore, enabled feeding status to be successful and efficiently changed from NPO to PO with no adverse health outcome. FEES was an efficient procedure with regard to appointment scheduling, transportation, patient issues, and personnel requirements.
Department of Surgery, Yale University School of Medicine, New Haven, CT 06504, USA.
S B
SB
Leder
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003679:Deglutition; D003680:Deglutition Disorders / Q000150:complications / Q000175:diagnosis* / Q000503:physiopathology / Q000628:therapy; D004750:Enteral Nutrition; D004945:Esophagoscopy / Q000379:methods*; D005215:Fasting; D005260:Female; D005336:Fiber Optic Technology; D006801:Humans; D008297:Male; D008875:Middle Aged; D018579:Patient Selection; D011015:Pneumonia, Aspiration / Q000209:etiology; D011446:Prospective Studies; D015203:Reproducibility of Results; D013997:Time Factors