title: Adding Endoscopist-Directed Flexible Endoscopic Evaluation of Swallowing to the Videofluoroscopic Swallowing Study Increased the Detection Rates of Penetration, Aspiration, and Pharyngeal Residue.
abstract: OBJECTIVE
  Currently, the videofluoroscopic swallowing study (VFSS) is the standard tool for evaluating dysphagia. We evaluated whether the addition of endoscopist-directed flexible endoscopic evaluation of swallowing (FEES) to VFSS could improve the detection rates of penetration, aspiration, and pharyngeal residue, compared the diagnostic efficacy between VFSS and endoscopist-directed FEES and assessed the adverse events of the FEES.
  
  
  METHODS
  In single tertiary referral center, a retrospective analysis of prospectively collected data was conducted. Fifty consecutive patients suspected of oropharyngeal dysphagia were enrolled in this study between January 2012 and July 2012.
  
  
  RESULTS
  The agreement in the detection of penetration and aspiration between VFSS and FEES of viscous food (κ=0.34; 95% confidence interval [CI], 0.15 to 0.53) and liquid food (κ=0.22; 95% CI, 0.02 to 0.42) was "fair." The agreement in the detection of pharyngeal residue between the two tests was "substantial" with viscous food (κ=0.63; 95% CI, 0.41 to 0.94) and "fair" with liquid food (κ=0.37; 95% CI, 0.10 to 0.63). Adding FEES to VFSS significantly increased the detection rates of penetration, aspiration, and pharyngeal residue. No severe adverse events were noted during FEES, except for two cases of epistaxis, which stopped spontaneously without requiring any packing.
  
  
  CONCLUSIONS
  This study demonstrated that the addition of endoscopist-directed FEES to VFSS increased the detection rates of penetration, aspiration, and pharyngeal residue.
authors.affiliation: Institute for Digestive Research, Digestive Disease Center, Soonchunhyang University College of Medicine, Seoul, Korea.
authors.forename: Won Young
authors.initials: WY
authors.lastname: Park
authors.affiliation: Institute for Digestive Research, Digestive Disease Center, Soonchunhyang University College of Medicine, Seoul, Korea.
authors.forename: Tae Hee
authors.initials: TH
authors.lastname: Lee
authors.affiliation: Institute for Digestive Research, Digestive Disease Center, Soonchunhyang University College of Medicine, Seoul, Korea.
authors.forename: Nam Seok
authors.initials: NS
authors.lastname: Ham
authors.affiliation: Department of Physical Medicine and Rehabilitation, Soonchunhyang University College of Medicine, Seoul, Korea.
authors.forename: Ji Woong
authors.initials: JW
authors.lastname: Park
authors.affiliation: Department of Physical Medicine and Rehabilitation, Soonchunhyang University College of Medicine, Seoul, Korea.
authors.forename: Yang Gyun
authors.initials: YG
authors.lastname: Lee
authors.affiliation: Institute for Digestive Research, Digestive Disease Center, Soonchunhyang University College of Medicine, Seoul, Korea.
authors.forename: Sang Jin
authors.initials: SJ
authors.lastname: Cho
authors.affiliation: Institute for Digestive Research, Digestive Disease Center, Soonchunhyang University College of Medicine, Seoul, Korea.
authors.forename: Joon Seong
authors.initials: JS
authors.lastname: Lee
authors.affiliation: Institute for Digestive Research, Digestive Disease Center, Soonchunhyang University College of Medicine, Seoul, Korea.
authors.forename: Su Jin
authors.initials: SJ
authors.lastname: Hong
authors.affiliation: Institute for Digestive Research, Digestive Disease Center, Soonchunhyang University College of Medicine, Seoul, Korea.
authors.forename: Seong Ran
authors.initials: SR
authors.lastname: Jeon
authors.affiliation: Institute for Digestive Research, Digestive Disease Center, Soonchunhyang University College of Medicine, Seoul, Korea.
authors.forename: Hyun Gun
authors.initials: HG
authors.lastname: Kim
authors.affiliation: Institute for Digestive Research, Digestive Disease Center, Soonchunhyang University College of Medicine, Seoul, Korea.
authors.forename: Joo Young
authors.initials: JY
authors.lastname: Cho
authors.affiliation: Institute for Digestive Research, Digestive Disease Center, Soonchunhyang University College of Medicine, Seoul, Korea.
authors.forename: Jin Oh
authors.initials: JO
authors.lastname: Kim
authors.affiliation: Institute for Digestive Research, Digestive Disease Center, Soonchunhyang University College of Medicine, Seoul, Korea.
authors.forename: Jun Hyung
authors.initials: JH
authors.lastname: Cho
authors.affiliation: Biostatistical Consulting Unit, Soonchunhyang University College of Medicine, Seoul, Korea.
authors.forename: Ji Sung
authors.initials: JS
authors.lastname: Lee
mesh_terms: D000368:Aged; D003679:Deglutition / Q000502:physiology*; D003680:Deglutition Disorders / Q000175:diagnosis* / Q000000981:diagnostic imaging; D005260:Female; D005471:Fluoroscopy / Q000379:methods; D006801:Humans; D007828:Laryngoscopy / Q000379:methods* / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D010614:Pharynx / Q000000981:diagnostic imaging; D015203:Reproducibility of Results; D012189:Retrospective Studies; D014741:Video Recording
keywords: Deglutition disorders; Endoscopy; Videofluoroscopic swallowing study