To clarify the reliability of fiberoptic endoscopic evaluation of swallowing (FEES) compared to videofluoroscopic swallowing studies (VFSSs). Second, we explored the effect of the chin-down maneuver in the presence or absence of vocal fold paralysis (VFP) using FEES in patients with 3-field lymphadenectomy (3FL) postesophagectomy.
Retrospective data collection from FEES and VFSS.
Dysphagic clinics in the ear, nose, and throat department.
Patients (N=15) underwent esophagectomy with 3FL at the Department of Gastroenterologic Surgery, during a period of 12 months.
The patients underwent FEES and VFSS with neutral and chin-down maneuvers 2 weeks postoperatively. Two raters of speech pathology blindly scored aspiration, penetration, delayed initiation, and pharyngeal clearance in the pyriform sinus and vallecula, respectively, from recorded movie clips of both examinations, using the penetration aspiration scale (PAS) and modified Hyodo FEES rating scale.
Main Outcome Measures
The intrarater and interrater correlation coefficients of each parameter examined with FEES. Statistical comparison of each parameter between FEES and VFSS and of each parameter evaluated using FEES between 2 maneuvers with or without VFP.
The intrarater and interrater correlation coefficients of the PAS and pyriform sinus examined with FEES were both statistically consistent between the 2 raters. The PAS and pyriform sinus evaluated using FEES were significantly correlated with those evaluated in a VFSS (P<.05). The 2 parameters evaluated using FEES were significantly (P<.05) improved with the chin-down maneuver compared to the neutral maneuver, especially in VFP patients.
FEES performed postesophagectomy with 3FL for evaluation of aspiration is as reliable statistically as VFSSs. The chin-down maneuver is especially useful for reducing the PAS score and pyriform sinus in VFP patients.
List of abbreviations:3FL (3-field lymphadenectomy), FEES (fiberoptic endoscopic evaluation of swallowing), PAS (penetration aspiration scale), UES (upper esophageal sphincter), VFP (vocal fold paralysis), VFSS (videofluoroscopic swallowing study)
To read this article in full you will need to make a payment
Purchase one-time access:Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
One-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:Subscribe to Archives of Physical Medicine and Rehabilitation
Already a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
- Lymph node metastasis and recurrence in patients with a carcinoma of the thoracic esophagus who underwent three-field dissection.World J Surg. 1994; 18: 266-272
- Three-field lymph node dissection for squamous cell and adenocarcinoma of the esophagus.Ann Surg. 2002; 236: 177-183
- Videofluoroscopic evaluation of pharyngeal swallowing dysfunction after esophagectomy with three-field lymph node dissection.Eur Arch Otorhinolaryngol. 2017; 274: 321-326
- Effects of chin-down maneuver on the parameters of swallowing function after esophagectomy with 3-field lymphadenectomy examined by videofluoroscopy.Arch Phys Med Rehabil. 2017; 98: 1174-1179
- Radical lymph node dissection for cancer of the thoracic esophagus.Ann Surg. 1994; 220: 364-373
- Transient diminished airway protection after transhiatal esophagectomy.Am J Surg. 1991; 162: 442-446
- Complications of transhiatal esophagectomy.Chest Surg Clin N Am. 1997; 7: 601-610
- Pharyngeal dysfunction after treatment for pharyngeal cancer with surgery and radiotherapy.Gastrointest Radiol. 1983; 8: 97-104
- Pharyngeal dysfunction after total and subtotal oesophagectomy.Acta Radiol. 1987; 28: 409-413
- Fiberoptic endoscopic evaluation of swallowing in assessing aspiration after transhiatal esophagectomy.J Am Coll Surg. 2007; 205: 581-585
- History of fiberoptic endoscopic evaluation of swallowing for evaluation and management of pharyngeal dysphagia: changes over the years.Dysphagia. 2017; 32: 27-38
- [New scoring proposed for endoscopic swallowing evaluation and clinical significance].Nihon Jibiinkoka Gakkai Kaiho. 2010; 113 ([Japanese]): 670-678
- Pharyngeal weakness and upper esophageal sphincter opening in patients with unilateral vocal fold immobility.Laryngoscope. 2014; 124: 2371-2374
- A penetration-aspiration scale.Dysphagia. 1996; 11: 93-98
- Endoscopic evaluation and treatment of swallowing disorders.1st ed. Thieme, New York2001
- Patient and peri-operative predictors of morbidity and mortality after esophagectomy: American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP), 2005-2008.J Gastrointest Surg. 2010; 14: 1492-1501
- Videomanometric analysis of supraglottic swallow, effortful swallow, and chin tuck in patients with pharyngeal dysfunction.Dysphagia. 2001; 16: 190-195
- Effect of three different chin-down maneuvers on swallowing pressure in healthy young adults.Laryngoscope. 2016; 126: 437-441
- Indications and techniques of endoscopy in evaluation of cervical dysphagia: comparison with radiographic techniques.Dysphagia. 1994; 9: 256-261
- Evaluation of oropharyngeal dysphagia: which diagnostic tool is superior?.Curr Opin Otolaryngol Head Neck Surg. 2003; 11: 485-489
- Normal swallowing physiology as viewed by videofluoroscopy and videoendoscopy.Folia Phoniatr Logop. 1998; 50: 311-319
- Prospective, randomized outcome study of endoscopy versus modified barium swallow in patients with dysphagia.Laryngoscope. 2000; 110: 563-574
- Parameters of instrumental swallowing evaluations: describing a diagnostic dilemma.Dysphagia. 2016; 31: 462-472
Published online: November 01, 2018
© 2018 by the American Congress of Rehabilitation Medicine