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

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, 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

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.

© The Author(s) 2019.

Figures

Fig. 1
Fig. 1
Tolerance, complications and alterations of cardiorespiratory parameters during FEES. a: Patients’ rating of FEES-associated discomfort ranging from none to severe; b: Incidence of complications; c: Incidence of complications in relation to the clinician’s FEES-experience. Numbers below columns give the number of FEES performed during prior training; d: Procedure-related changes of oxygen saturation (SaO2); E: Procedure-related changes of systolic blood pressure (RRsys); F: Procedure-related changes of heart rate (HR)
Fig. 2
Fig. 2
Correlation of the FEES-based dysphagia score with the Functional Oral Intake Score (FOIS)
Fig. 3
Fig. 3
Changes of dysphagia management after FEES. a: Detailed changes of FOIS score after FEES. A positive value indicates an upgrade of the FOIS score after FEES, a negative value indicates more restrictive feeding strategy. b: Summary of FOIS changes and management of tracheotomised patients with regards to decannulation

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