Towards a basic endoscopic evaluation of swallowing in acute stroke – identification of salient findings by the inexperienced examiner

Abstract Background Dysphagia is common after stroke. Fiberoptic endoscopic evaluation of swallowing (FEES) is a powerful tool for dysphagia assessment. The purpose of this study was to assess whether a previously established endoscopic examination protocol based on the identification of typical findings indicative of stroke – related dysphagia may be learned and adopted by clinicians so far inexperienced in this field. Methods After receiving a structured lecture on this topic, participants were asked to rate video sequences of endoscopic swallowing examinations of acute stroke patients. The first part of the testing ("single findings-rating") comprised of 16 single sequences, the second part ("complete examination-rating") presented the key sequences of 8 complete examinations. Before the second part was started, results of the first were discussed. Results At the "single findings-rating" 88.8% of video-sequences were assessed correctly, while at the "complete examination-rating" the average performance had improved to 96%. Furthermore, no overlooking of relevant pathologies was noted in the second part of the testing. Conclusion This study suggests that the presented endoscopic examination protocol is reliably interpreted by inexperienced clinicians after a short lecture and may therefore easily and successfully be adopted in dysphagia management of acute stroke care.</p

Validation of the DIGEST-FEES as a Global Outcome Measure for Pharyngeal Dysphagia in Parkinson’s Disease

&lt;jats:title&gt;Abstract&lt;/jats:title&gt;&lt;jats:p&gt;Flexible Endoscopic Evaluation of Swallowing (FEES) is one of two diagnostic gold standards for pharyngeal dysphagia in Parkinson's disease (PD), however, validated global outcome measures at the patient level are widely lacking. The Dynamic Imaging Grade of Swallowing Toxicity for Flexible Endoscopic Evaluation of Swallowing (DIGEST-FEES) represents such an outcome measure but has been validated primarily for head and neck cancer collectives. The objective of this study was, therefore, to investigate the validity of the DIGEST-FEES in patients with PD. Content validity was evaluated with a modified Delphi expert survey. Subsequently, 66 FEES videos in PD patients were scored with the DIGEST-FEES. Criterion validity was determined using Spearman's correlation coefficient between the DIGEST-FEES and the Penetration-Aspiration Scale (PAS), the Yale-Residue-Rating-Scale, the Functional-Oral-Intake-Scale (FOIS), and the swallowing-related Unified-Parkinson-Disease-Rating-Scale (UPDRS) items. Inter-rater reliability was determined using 10 randomly selected FEES-videos examined by a second rater. As a result, the overall DIGEST-FEES-rating exhibited significant correlations with the Yale-Valleculae-Residue-Scale (&lt;jats:italic&gt;r&lt;/jats:italic&gt; = 0.84; &lt;jats:italic&gt;p&lt;/jats:italic&gt; &amp;lt; 0.001), the Yale-Pyriform-Sinus-Residue-Scale (&lt;jats:italic&gt;r&lt;/jats:italic&gt; = 0.70; &lt;jats:italic&gt;p&lt;/jats:italic&gt; &amp;lt; 0.001), the FOIS (&lt;jats:italic&gt;r&lt;/jats:italic&gt; =  − 0.55, &lt;jats:italic&gt;p&lt;/jats:italic&gt; &amp;lt; 0.001), and the UPDRS-Swallowing-Item-Score (&lt;jats:italic&gt;r&lt;/jats:italic&gt; = 0.42, &lt;jats:italic&gt;p&lt;/jats:italic&gt; &amp;lt; 0.001). Further, the DIGEST-FEES-safety subscore correlated with the PAS (&lt;jats:italic&gt;r&lt;/jats:italic&gt; = 0.63, &lt;jats:italic&gt;p&lt;/jats:italic&gt; &amp;lt; 0.001). Inter-rater reliability was high for the overall DIGEST-FEES rating (quadratic weighted kappa of 0.82). Therefore, DIGEST-FEES is a valid and reliable score to evaluate overall pharyngeal dysphagia severity in PD. Nevertheless, the modified Delphi survey identified domains where DIGEST-FEES may need to be specifically adapted to PD or neurological collectives in the future.&lt;/jats:p&gt