Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress 2023 EHA Congress 2023 ASCO Annual Meeting
Clinical Collections
Advances in Alzheimer’s

At a glance: The ONWARDS insulin icodec trials

A round-up of the ONWARDS phase 3 clinical trials evaluating the novel weekly insulin icodec in people with diabetes.
ADVANCED SEARCH
Log in
Top
Neurological Research and Practice
Published in: Neurological Research and Practice 1/2019

Open Access 01-12-2019 | Stroke | Research article

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

Authors: Rainer Dziewas, Matthias auf dem Brinke, Ulrich Birkmann, Götz Bräuer, Kolja Busch, Franziska Cerra, Renate Damm-Lunau, Juliane Dunkel, Amelie Fellgiebel, Elisabeth Garms, Jörg Glahn, Sandra Hagen, Sophie Held, Christine Helfer, Mirko Hiller, Christina Horn-Schenk, Christoph Kley, Nikolaus Lange, Sriramya Lapa, Christian Ledl, Beate Lindner-Pfleghar, Marion Mertl-Rötzer, Madeleine Müller, Hermann Neugebauer, Duygu Özsucu, Michael Ohms, Markus Perniß, Waltraud Pfeilschifter, Tanja Plass, Christian Roth, Robin Roukens, Tobias Schmidt-Wilcke, Beate Schumann, Julia Schwarze, Kathi Schweikert, Holger Stege, Dirk Theuerkauf, Randall S. Thomas, Ulrich Vahle, Nancy Voigt, Hermann Weber, Cornelius J. Werner, Rainer Wirth, Ingo Wittich, Hartwig Woldag, Tobias Warnecke

Published in: Neurological Research and Practice | Issue 1/2019

Login to get access

Abstract

Background

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.

Methods

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.

Results

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.

Discussion

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.

Trial registration

ClinicalTrials.​gov NCT03037762, registered January 31st 2017.
Literature
1.
Martino, R., Foley, N., Bhogal, S., Diamant, N., Speechley, M., & Teasell, R. (2005). Dysphagia after stroke - incidence, diagnosis, and pulmonary complications. Stroke; a Journal of Cerebral Circulation, 36, 2756–2763.CrossRef
2.
Morgan, A. S., & Mackay, L. E. (1999). Causes and complications associated with swallowing disorders in traumatic brain injury. The Journal of Head Trauma Rehabilitation, 14, 454–461.CrossRef
3.
Kalf, J. G., de Swart, B. J., Bloem, B. R., & Munneke, M. (2012). Prevalence of oropharyngeal dysphagia in Parkinson's disease: A meta-analysis. Parkinsonism & Related Disorders, 18(4), 311–315.CrossRef
4.
Langmore, S. E., Olney, R. K., Lomen-Hoerth, C., & Miller, B. L. (2007). Dysphagia in patients with frontotemporal lobar dementia. Archives of Neurology, 64(1), 58–62.CrossRef
5.
Kühnlein, P., Gdynia, H. J., Sperfeld, A. D., Lindner-Pfleghar, B., Ludolph, A. C., Prosiegel, M., & Riecker, A. (2008). Diagnosis and treatment of bulbar symptoms in amyotrophic lateral sclerosis. Nature Clinical Practice. Neurology, 4, 366–374.CrossRef
6.
Grob, D., Arsura, L., Brunner, N. G., & Namba, R. (1987). The course of myasthenia gravis and therapies affecting outcome. Annals of the New York Academy of Sciences, 505, 472–499.CrossRef
7.
Guan, X. L., Wang, H., Huang, H. S., & Meng, L. (2015). Prevalence of dysphagia in multiple sclerosis: A systematic review and meta-analysis. Neurological sciences : official journal of the Italian Neurological Society and of the Italian Society of Clinical Neurophysiology, 36(5), 671–681.CrossRef
8.
Altmann, K. W., Yu, G. P., & Schaffer, S. D. (2010). Consequence of dysphagia in the hospitalized patient: Impact on prognosis and hospital ressources. Archives of otolaryngology--head & neck surgery, 136, 784–789.CrossRef
9.
Holland, G., Jayasekeran, V., Pendleton, N., Horan, M., Jones, M., & Hamdy, S. (2011). Prevalence and symptom profiling of oropharyngeal dysphagia in a community dwelling of an elderly population: A self-reporting questionnaire survey. Diseases of the Esophagus, 24(7), 476–480.CrossRef
10.
Ekberg, O., Hamdy, S., Woisard, V., Wuttge-Hannig, A., & Ortega, P. (2002). Social and psychological burden of dysphagia: Its impact on diagnosis and treatment. Dysphagia, 17(2), 139–146.CrossRef
11.
Langmore, S. E., Schatz, K., & Olsen, N. (1988). Fiberoptic endoscopic examination of swallowing safety: A new procedure. Dysphagia, 2, 216–219.CrossRef
12.
Langmore, S. E. (2017). History of Fiberoptic endoscopic evaluation of swallowing for evaluation and Management of Pharyngeal Dysphagia: Changes over the years. Dysphagia, 32(1), 27–38.CrossRef
13.
Lapa, S., Luger, S., Pfeilschifter, W., Henke, C., Wagner, M., & Foerch, C. (2017). Predictors of dysphagia in acute pontine infarction. Stroke; a Journal of Cerebral Circulation, 48(5), 1397–1399.CrossRef
14.
Leder, S. B. (1999). Fiberoptic endoscopic evaluation of swallowing in patients with acute traumatic brain injury. The Journal of Head Trauma Rehabilitation, 14(5), 448–453.CrossRef
15.
Bader, C. A., & Niemann, G. (2010). Dysphagia in children with cerebral palsy--fiberoptic-endoscopic findings. Laryngo- Rhino- Otologie, 89(2), 90–94.CrossRef
16.
Warnecke, T., Oelenberg, S., Teismann, I., Hamacher, C., Lohmann, H., & Ringelstein, E. B. (2010). Dziewas R: Endoscopic characteristics and levodopa responsiveness of swallowing function in progressive supranuclear palsy. Movement Disorders, 25, 1239–1245.CrossRef
17.
Pflug, C., Bihler, M., Emich, K., Niessen, A., Nienstedt, J. C., Flugel, T., Koseki, J. C., Plaetke, R., Hidding, U., Gerloff, C., et al. (2018). Critical dysphagia is common in Parkinson disease and occurs even in early stages: A prospective cohort study. Dysphagia, 33(1), 41–50.CrossRef
18.
Leder, S. B., Novella, S., & Patwa, H. (2004). Use of fiberoptic endoscopic evaluation of swallowing (FEES) in patients with amyotrophic lateral sclerosis. Dysphagia, 19(3), 177–181.CrossRef
19.
Warnecke, T., Oelenberg, S., Teismann, I., Suntrup, S., Hamacher, C., Young, P., & Ringelstein, E. B. (2009). Dziewas R: Dysphagia in X-linked bulbospinal muscular atrophy (Kennedy disease). Neuromuscular Disorders, 19, 704–708.CrossRef
20.
Deutschmann, M. W., McDonough, A., Dort, J. C., Dort, E., Nakoneshny, S., & Matthews, T. W. (2013). Fiber-optic endoscopic evaluation of swallowing (FEES): Predictor of swallowing-related complications in the head and neck cancer population. Head & Neck, 35(7), 974–979.CrossRef
21.
Willging, J. P., & Thompson, D. M. (2005). Pediatric FEESST: Fiberoptic endoscopic evaluation of swallowing with sensory testing. Current Gastroenterology Reports, 7(3), 240–243.CrossRef
22.
Leder, S. B., Suiter, D. M., Agogo, G. O., & Cooney, L. M., Jr. (2016). An epidemiologic study on ageing and dysphagia in the acute care geriatric-hospitalized population: A replication and continuation study. Dysphagia, 31(5), 619–625.CrossRef
23.
Hafner, G., Neuhuber, A., Hirtenfelder, S., & Schmedler, B. (2008). Eckel HE: Fiberoptic endoscopic evaluation of swallowing in intensive care unit patients. European Archives of Oto-Rhino-Laryngology, 265, 441–446.CrossRef
24.
Marian, T., Dunser, M., Citerio, G., Kokofer, A., & Dziewas, R. (2018). Are intensive care physicians aware of dysphagia? The MAD(ICU) survey results. Intensive Care Medicine, 44(6), 973–975.CrossRef
25.
Dziewas, R., Glahn, J., Helfer, C., Ickenstein, G., Keller, J., Ledl, C., Lindner-Pfleghar, B., D, G. N., Prosiegel, M., Riecker, A., et al. (2016). Flexible endoscopic evaluation of swallowing (FEES) for neurogenic dysphagia: Training curriculum of the German Society of Neurology and the German stroke society. BMC Medical Education, 16, 70.CrossRef
26.
Dziewas, R., Glahn, J., Helfer, C., Ickenstein, G., Keller, J., Lapa, S., Ledl, C., Lindner-Pfleghar, B., Nabavi, D., Prosiegel, M., et al. (2014). FEES for neurogenic dysphagia: Training curriculum of the German Society of Neurology and the German stroke society. Der Nervenarzt, 85(8), 1006–1015.CrossRef
27.
Dziewas, R., Baijens, L., Schindler, A., Verin, E., Michou, E., & Clave, P. (2017). European Society for Swallowing Disorders FEES accreditation program for neurogenic and geriatric oropharyngeal dysphagia. Dysphagia.
28.
Wade, D. T., & Collin, C. (1988). The Barthel ADL index: A standard measure of physical disability? International Disability Studies, 10(2), 64–67.CrossRef
29.
Sessler, C. N., Gosnell, M. S., Grap, M. J., Brophy, G. M., O'Neal, P. V., Keane, K. A., Tesoro, E. P., & Elswick, R. K. (2002). The Richmond agitation-sedation scale: Validity and reliability in adult intensive care unit patients. American Journal of Respiratory and Critical Care Medicine, 166(10), 1338–1344.CrossRef
30.
Crary, M. A., Mann, G. D., & Groher, M. E. (2005). Initial psychometric assessment of a functional oral intake scale for dysphagia in stroke patients. Archives of Physical Medicine and Rehabilitation, 86(8), 1516–1520.CrossRef
31.
Warnecke, T., Suttrup, I., Schroder, J. B., Osada, N., Oelenberg, S., Hamacher, C., Suntrup, S., & Dziewas, R. (2016). Levodopa responsiveness of dysphagia in advanced Parkinson's disease and reliability testing of the FEES-levodopa-test. Parkinsonism & Related Disorders, 28, 100–106.CrossRef
32.
Aviv, J. E., Kaplan, S. T., Thomson, J. E., Spitzer, J., Diamond, B., & Close, L. G. (2000). The safety of flexible endoscopic evaluation of swallowing with sensory testing (FEESST): An analysis of 500 consecutive evaluations. Dysphagia, 15(1), 39–44.CrossRef
33.
Cohen, M. A., Setzen, M., & Perlman, P. W. (2003). The safety of flexible endoscopic evaluation of swallowing with sensory testing in an outpatient otolaryngology setting. The Laryngoscope, 113, 21–24.CrossRef
34.
Langmore, S. E. (2001). Endoscopic evaluation and treatment of swallowing disorders. New York. Stuttgart: Thieme.
35.
Nacci, A., Matteucci, J., Romeo, S. O., Santopadre, S., Cavaliere, M. D., Barillari, M. R., Berrettini, S., & Fattori, B. (2016). Complications with Fiberoptic endoscopic evaluation of swallowing in 2,820 examinations. Folia phoniatrica et logopaedica : official organ of the International Association of Logopedics and Phoniatrics (IALP), 68(1), 37–45.CrossRef
36.
Warnecke, T., Teismann, I., Oelenberg, S., Hamacher, C., Ringelstein, E. B., Schabitz, W. R., & Dziewas, R. (2009). The safety of fiberoptic endoscopic evaluation of swallowing in acute stroke patients. Stroke; a Journal of Cerebral Circulation, 40, 482–486.CrossRef
37.
Dziewas, R., Schilling, M., Konrad, C., Stögbauer, F., & Lüdemann, P. (2003). Placing nasogastric tubes in stroke patients with dysphagia: Efficiency and tolerability of the reflex-placement. Journal of Neurology, Neurosurgery, and Psychiatry, 74, 1429–1431.CrossRef
38.
Dziewas, R., Beck, A. M., Clave, P., Hamdy, S., Heppner, H. J., Langmore, S. E., Leischker, A., Martino, R., Pluschinski, P., Roesler, A., et al. (2017). Recognizing the importance of dysphagia: Stumbling blocks and stepping stones in the twenty-first century. Dysphagia, 32(1), 78–82.CrossRef
39.
Bax, L., McFarlane, M., Green, E., & Miles, A. (2014). Speech-language pathologist-led fiberoptic endoscopic evaluation of swallowing: Functional outcomes for patients after stroke. Journal of Stroke and Cerebrovascular Diseases : The Official Journal of National Stroke Association, 23(3), e195–e200.CrossRef
40.
Warnecke, T., Suntrup, S., Teismann, I. K., Hamacher, C., Oelenberg, S., & Dziewas, R. (2013). Standardized endoscopic swallowing evaluation for tracheostomy decannulation in critically ill neurologic patients. Critical Care Medicine, 41(7), 1728–1732.CrossRef
41.
O'Dea, M. B., Langmore, S. E., Krisciunas, G. P., Walsh, M., Zanchetti, L. L., Scheel, R., McNally, E., Kaneoka, A. S., Guarino, A. J., & Butler, S. G. (2015). Effect of lidocaine on swallowing during FEES in patients with dysphagia. The Annals of Otology, Rhinology, and Laryngology, 124(7), 537–544.CrossRef
Metadata
Title
Safety and clinical impact of FEES – results of the FEES-registry
Authors
Rainer Dziewas
Matthias auf dem Brinke
Ulrich Birkmann
Götz Bräuer
Kolja Busch
Franziska Cerra
Renate Damm-Lunau
Juliane Dunkel
Amelie Fellgiebel
Elisabeth Garms
Jörg Glahn
Sandra Hagen
Sophie Held
Christine Helfer
Mirko Hiller
Christina Horn-Schenk
Christoph Kley
Nikolaus Lange
Sriramya Lapa
Christian Ledl
Beate Lindner-Pfleghar
Marion Mertl-Rötzer
Madeleine Müller
Hermann Neugebauer
Duygu Özsucu
Michael Ohms
Markus Perniß
Waltraud Pfeilschifter
Tanja Plass
Christian Roth
Robin Roukens
Tobias Schmidt-Wilcke
Beate Schumann
Julia Schwarze
Kathi Schweikert
Holger Stege
Dirk Theuerkauf
Randall S. Thomas
Ulrich Vahle
Nancy Voigt
Hermann Weber
Cornelius J. Werner
Rainer Wirth
Ingo Wittich
Hartwig Woldag
Tobias Warnecke
Publication date
01-12-2019
Publisher
BioMed Central
Published in
Neurological Research and Practice / Issue 1/2019
Electronic ISSN: 2524-3489
DOI
https://doi.org/10.1186/s42466-019-0021-5

Other articles of this Issue 1/2019

Neurological Research and Practice 1/2019 Go to the issue

Research article

Ulnar nerve integrity predicts 1-year outcome in cervical spinal cord injury

Research article

Anodal tDCS over left parietal cortex expedites recovery from stroke-induced apraxic imitation deficits: a pilot study

Research article

Inpatient TIA and stroke care in adult patients in Germany - retrospective analysis of nationwide administrative data sets of 2011 to 2017

Review

Human immunodeficiency virus and multiple sclerosis: a review of the literature

Letter to the editor

Neuro-Sweet syndrome - a rare differential diagnosis in aseptic meningoencephalitis

Research article

HDMTX-based induction therapy followed by consolidation with conventional systemic chemotherapy and intraventricular therapy (modified Bonn protocol) in primary CNS lymphoma: a monocentric retrospective analysis