Auteur, jaartal

Reden van exclusie

Syst. review

Baijens, 2013

Als uitkomstmaat is gekeken naar de inter- en intrarater reliability bij VFS, géén vergelijking met FEES. Studie benoemt dat de geïncludeerde studies niet allemaal voldoen aan externe en interne validiteit

Brady 2013

Modified barium swallow (=VFSS) vs endoscopy. Dit is géén systematische review maar een beschrijvend artikel

O’Donoghue, 1999

Géén vergelijking met FEES, sensitiviteit en specificiteit niet benoemd als uitkomstmaten, er is wel gekeken naar interrater reliability, P= kinderen en volwassenen

Perry, 2001

Artikel beschrijft de screeningsmethoden die beschikbaar zijn bij beroerte, en de effecten van het screenen van de slikfunctie. Géén vergelijking tussen VFS en FEES

Ramsey, 2003

Artikel gaat over bedside screening tests, waarbij één studie is geïncludeerd die FEES vergelijkt met VFS: Langmore, 1991 (geïncludeerd)

Doggett, 2002

Artikel gaat over de impact van het evidence-based AHRQ rapport op de diagnose en behandeling van patiënten met o.a. een beroerte.

Langmore, 2003

Dit is géén systematische review, maar een beschrijvend artikel

RCTs

Aviv, 2000

Geen vergelijking tussen VFS met FEES.

Stoeckli, 2003

Er wordt géén vergelijking gemaakt met FEES en als uitkomstmaat wordt er gekeken naar de interrater reliability

Diverse designs

Caliceti, 2004

Voldoet niet aan de PICO, zowel videofluoroscopie en endoscopie zijn uitgevoerd bij patiënten met als doel betere beeldvorming

Colodny, 2002

Er wordt géén vergelijking gemaakt tussen VFSS en FEES in deze studie, VFSS en FEES worden beoordeeld met behulp van de Penetration-Aspiration-scale

Finkelstein, 2002

Is een letter to the editor

Logemann, 1998

Sensitiviteit en specificiteit zijn niet onderzocht, fluoroscopie en endoscopie worden toegepast bij gezonde personen om aan te tonen welke slikfysiologie beter zichtbaar is met welke methode

Miller, 2014

Gaat over niet-instrumentale diagnostische procedures

Ott, 1990

Gaat over endoscopie versus manometrie

Speyer, 2013

Geenn vergelijking tussen VFS en FEES

Walther, 2000

Andere methoden zijn onderzocht

Study reference

Study characteristics

Patient characteristics

Index test

(test of interest)

Reference test

Follow-up

Outcome measures and effect size

Comments

Langmore, 1991

Prospective study design

USA

No conflicts of interest mentioned

Inclusion criteria:

Not mentioned

Exclusion criteria:

Not mentioned

N= 21

Mean age: 63

Sex: 100% M

Diagnosis: dysphagia

Fiberoptic endoscopic evaluation of swallowing (FEES)

Place of the test in the clinical pathway^[1]: replacement

Videofluoroscopy (VFS)

FEES and VFS were performed within 48 hours.

Outcome measures: Sensitivity; specificity:

Tracheal aspiration: 88%; 92%

Laryngeal penetration: 100%; 75%

Premature spillage: 75%; 56%

Pharyngeal residue: 93%; 50%

Agreement between both methods:

Aspiration: 90%

Penetration: 85%

Residue: 80%

Spillage: -

Less than 50% of the examinations were in total agreement with regard to all 4 parameters

Positive and negative predictive value in aspiration:

PPV: 88%; NPV: 92%

Positive and negative predictive value in penetration:

PPV: 75%; NPV: 100%

FEES is a valid and valuable tool for evaluating oropharyngeal dysphagia

Kelly, 2007

Prospective, single-blind study

UK

No conflicts of interest mentioned

Inclusion criteria: referred to speech and language therapy for assessment of dysphagia

Exclusion criteria: nil by mouth or judged to be at high

risk of aspiration

N= 15

Mean age: 53,4 years

Sex: 51% M

Diagnosis: dysphagia

Fiberoptic endoscopic evaluation of swallowing (FEES)

Place of the test in the clinical pathway^[2]: replacement

Setting: Tertiary specialist ENT teaching hospital

Videofluoroscopy (VFS)

FEES and Videofluoroscopic examination were performed and recorded simultaneously

Outcome measures: Penetration and aspiration

Interrater agreement VFS: 0,67

Inter-rater agreement FEES: 0,64

Intra-rater agreement VFS: 0,79

Intra-rater agreement FEES: 0,73

Same methods and materials are used as with Kelly, 2006.

Penetration and aspiration are perceived to be more

severe from FEES than from videofluoroscopy. This has serious

implications for the interchangeable use of these examinations

in clinical practice.

Kelly, 2006

Prospective, single-blind study

UK

No conflicts of interest mentioned

Inclusion criteria: referred to speech and language therapy for assessment of dysphagia

Exclusion criteria: nil by mouth or judged to be at high

risk of aspiration

N= 15

Mean age: 53,4 years

Sex: 51% M

Diagnosis: dysphagia

Fiberoptic endoscopic evaluation of swallowing (FEES)

Place of the test in the clinical pathway^[3]: replacement

Setting: Tertiary specialist ENT teaching hospital

Videofluoroscopy (VFS)

FEES and Videofluoroscopic examination were performed and recorded simultaneously

Outcome: Residue

Interrater agreement VFS: 0,56

Interrater agreement FEES: 0,51

Intrarater agreement VFS: 0,74

Intrarater agreement FEES: 0,72

Conclusions: Pharyngeal residue was consistently perceived to be greater from FEES than from videofluoroscopy.

These findings have significant clinical implications as FEES and videofluoroscopy findings are used to judge aspiration risk and to make recommendations for oral intake. Further research is required to examine the impact of FEES and videofluoroscopy examinations on treatment decisions.

Same methods and materials are used as with Kelly, 2007

Leder, 2000

Prospective, consecutive, blinded study

USA

No conflicts of interest are mentioned

Inclusion criteria:

Not mentioned.

Exclusion criteria:

Not mentioned.

N= 30

Mean age: 10 years and 4 months (11 days – 20 years)

Sex: 19 boys (63%)

Diagnosis: motor vehicle crash (8);

neurologic, i.e., cerebrovascular accident, encephalitis, tumor, and traumatic brain injury (7); gunshot wound or stabbing (3); laryngotracheal abnormalities, i.e., vocal fold paralysis and subglottic

stenosis (3); and 1 each for acetaminophen overdose, bronchopulmonary

dysplasia, DiGeorge’s syndrome, gastroesophageal

reflux disease, patent ductus arteriosis, Lennox-Gastaut syndrome,

necrotizing enterocolitis, short Y chromosome, and poor feeding.

Fiberoptic endoscopic evaluation of swallowing (FEES)

Place of the test in the clinical pathway^[4]: replacement?

Acute care setting of a large urban tertiary care teaching hospital. 7 out of 30 pediatric patients were assessed with both VFES and FEES, 23 patients with only FEES.

Videofluoroscopic evaluation of swallowing (VFES)

Seven of 30 subjects (23%) were tested on the same day with both VFES and FEES and 23 of 30 subjects (77%) were tested solely with FEES.

Diagnosis of dysphagia was determined by spillage, residue, laryngeal penetration, and aspiration.

There was 100% agreement between the blinded diagnostic results of FEES and VFES.

Conclusion: FEES can be used routinely to

diagnose and treat pediatric dysphagia in the acute care setting.

Da Silva, 2010

Cross-sectional study

Brazil

No conflicts of interest are mentioned

Inclusion criteria:

Not mentioned

Exclusion criteria:

Not mentioned

N= 30

Mean age ± SD: 25.8 months ± 21.2 (10.5-37.3)

Sex: 60% M

Diagnosis: suspected dysphagia due to cerebral palsy (n=11), genetic malformations (n=4), GER (n=4), respiratory diseases (n=18), other (n=6).

Fiberoptic endoscopic evaluation of swallowing (FEES)

Place of the test in the clinical pathway^[5]: Replacement

Setting: All patients were referred from the outpatient clinic and hospital admission desk of Hospital da Criança Santo Antônio (HCSA) due to suspected dysphagia.

Videofluoroscopic swallowing study (VFSS)

FEES and VFSS are performed directly after each other, without any preset order.

Interobserver agreement rates greater than 70 percent were obtained for all FEES parameters analyzed, except for pharyngeal residues with puree consistency (agreement = 66.7%, ƙ = 0.296, P = 0.091). Laryngeal aspiration and penetration yielded the best level of agreement (100%, ƙ = 1) for the laryngeal aspiration of puree residues.

Parameters: Sensitivity (%); specificity (%):

- Early spillover puree: 11,1; 81,0

- Early spillover liquid: 44,4; 76,2

- Ph. Residues puree: 80,0; 75,0

- Ph. Residues liquid: 83,3; 79,2

- Lar. penetr. puree: 0,0; 86,2

- Lar. penetr. liquid: 55,6; 52,4

- Laryngotrach. aspiration puree: / ; 100,0

- Laryngotrach. Aspiration liquid: 27,8; 91,7

Positive and negative predictive value in aspiration:

PPV: 83,3%; NPV: 45,8-90,0%

Positive and negative predictive value in penetration:

PPV: 33,3%; NPV: 73,3-96,3%

FEES may be used as a

complement to VFSS or as an alternative when the latter is not

possible, because it can provide reproducible predictive results

concerning tracheobronchial aspiration and pneumonia, that is,

laryngeal penetration and aspiration.

Madden, 2000

Prospective study

Ireland

No conflicts of interest are mentioned

Inclusion criteria:

Not mentioned

Exclusion criteria:

Not mentioned

N= 20 sets of videofluoroscopic and endoscopic assessments of swallowing function during a 1-year period.

Mean age: 65 years

Sex: 71% M

Diagnosis: clinical suspicion of aspiration following head and neck surgery or as a consequence of a stroke

Milk-swallow nasendoscopy

During nasendoscopy, the patient was asked to swallow 10mL boluses of milk

Place of the test in the clinical pathway^[6]: Replacement

Videofluoroscopy (VFS)

Both sets of assessment were performed within a 2-week period of each other

Outcome measures: Sensitivity (%); specificity (%):

- Laryngeal elevation 100; 88

- Pooling: 88; 100

- Aspiration: 94; 100

- Reflexive cough: 100; 86

Positive and negative predictive value in aspiration:

PPV: 91%; NPV: 86%

Milk-swallow endoscopy is

most e€ective as a primary tool for screening of dysphagic patients, for follow-up of patients postoperatively or during

swallowing therapy. It allows video¯uoroscopy to be used on a more selective basis and thus we feel that both techni-

ques are not exclusive but complimentary.

Noordally, 2011

Prospective, observational study

Belgium

No conflicts of interest are mentioned

Inclusion criteria:

patients older than 18 years, intubated and ventilated for

48 hours or more, and without swallowing disorders

documented prior to hospitalization.

Exclusion criteria: those who were intubated for less than 48 hours;

had a previous history of ear, nose, and throat surgery; or

a documented history of past or present tracheotomy.

N= 21

Mean age ± SD: 70.9 ± 12.1

Sex: 76% M

Mean (SD) length of intubation: 7.9 (6.59) days

Mean (SD) Acute Physiology and

Chronic Health Evaluation (APACHE) II score: 21.2 (7.16)

Mean (SD) body mass index (BMI): 24.8 (4.41) kg/m2

Fiber-Optic Endoscopic Evaluation of Swallowing (FEES)

Place of the test in the clinical pathway^[7]: Replacement

Setting: the adult intensive care unit (ICU) of a university hospital

Videofluoroscopy (VFS)

Clinical evaluation of swallowing and FEES

were performed within 24 hours. This was repeated at 48 hours with a videofluoroscopic

evaluation with identical swallowing, namely,

boluses of liquid and thickened water.

Outcome measures and effect size (include 95%CI and p-value if available):

There is a good correlation

between FEES and videofluoroscopy as opposed to clinical assessment and videofluoroscopy (P < .001 vs P = .762).

The correlation between fiberscopy and videofluoroscopy varies between 0.53-0.88

Perie, 1998

Prospective blind study

USA

No conflicts of interest are mentioned

Inclusion criteria:

Not mentioned

Exclusion criteria:

Not mentioned

N= 34

Mean age: 65,7

Sex: 47 % M

Diagnosis: oropharyngeal dysphagia

Videoendoscopic swallowing study (VESS)

Place of the test in the clinical pathway^[8]:

Replacement

Setting:

Videofluoroscopy (VFS) and manometry

Examination was within 15 days.

Pharyngeal propulsion and aspiration agreement between both methods was respectively 76,4% and 82,3%.

Specificity of VESS for aspiration: 87,5%, sensitivity: 70%

Specificity of VESS for pharyngeal propulsion: 88,8%-90%

Videoendoscopy is an examination that can be used to detect inexpensively pharyngeal propulsion disorders and aspiration episodes

Schroter-Morasch

Prospective study

Germany

No conflicts of interest are mentioned

Inclusion criteria:

Not mentioned

Exclusion criteria:

Not mentioned

N= 39

Mean age: 57

Sex: 66% M

Other important characteristics: dysphagia

Videoendoscopic examination

Place of the test in the clinical pathway^[9]: Replacement

 Setting:

Videofluoroscopic swallowingexamination (VFS)

Endoscopic and radiographic

examinations were performed within a narrow time

span (median 7 days, range 1–20 days).

Aspiration:

Correltation coefficient = 0,52, p<1%

Penetration:

Correlation coefficient = 0,49, p<1%

In conclusion, endoscopic methods shouldbe used as a clinical standard like bedside examination, in order to identify the presence of swallowing problems, to evaluate the underlying structural and functional deficits,

and to decide about the primary therapeutic

steps to be taken for the patient’s safety in respiration and feeding. The two methods should be considered complementary.

Singh, 2009

Retrospective study

UK

No conflicts of interest are mentioned

Inclusion criteria:

Not mentioned

Exclusion criteria:

Not mentioned

N= 100

Age: 19 to 100 years old

Sex: 63% M

Diagnosis: neurological dysphagia

Milk-nasoendoscopy

Place of the test in the clinical pathway^[10]: Replacement

Setting: multidisciplinary dysphagia clinic in Salisbury District Hospital involving the departments of Otolaryngology, Clinical Radiology and Speech

and Language Therapy.

Videofluoroscopy (VFS)

Both methods are performed at the same day

Overall milk nasendoscopy detected 77 (85%) of the 91

episodes of aspiration and videofluoroscopy detected 68

(75%) episodes. In 58% of the episodes, both findings showed signs of aspiration.

A substantial correlation was observed in detection of aspiration between videofluoroscopy and milk nasendoscopy in the present study. We suggest that milk nasendoscopy

should be used as a preliminary clinic-based test thereby reducing the need for investigations requiring radiation

doses.

Tabaee, 2006

Patient-controlled comparison

USA

No conflicts of interest are mentioned

Inclusion criteria: Not mentioned

Exclusion criteria:

Not mentioned

N= 54

Mean age: 72 (31-97)

Sex: 65% M

Diagnosis: Dysphagia

Flexible endoscopic evaluation of swallowing with sensory testing (FEESST).

Place of the test in the clinical pathway^[11]:

Replacement?

Setting: A retrospective review of all patients who underwent both FEESST and VFS at our institution between January 2001 and

March 2005 was performed.

Videofluoroscopy (VFS)

The mean time between the

two examinations was 5.4 days, both test had to be performed within two weeks.

All data was available because this study is retrospective.

Comparison of FEESST and VFS revealed full agreement in 52%, minor disagreement in 13%, and major disagreement in 35% of patients.

Outcome measures are pooling, aspiration and penetration.

FEESST and VFS may not represent comparable tests of dysphagia. Further comparative studies of tests of swallowing function are required to determine the ideal approach to dysphagia testing.

Wu, 1997

Controlled comparative study

Taiwan

No conflicts of interest are mentioned

Inclusion criteria: Not mentioned

Exclusion criteria:

Not mentioned

N= 28

Mean age: 64,7 years

Sex: 61 % M

Diagnosis: chronic dysphagia (N=22 CVA, N=1 Parkinson, N=1 head injury, N=4 nasopharryngeal carcinoma patients irradiated for more than 10 years)

Fiberoptic endoscopic evaluation of swallowing (FEES)

Place of the test in the clinical pathway^[12]: Replacement

Setting: Not mentioned

Videofluoroscopy (VFS)

Both tests are performed within two weeks.

Disagreement between FEES and VFS in:

- Premature oral leakage: 39.3%

- Pharyngeal stasis: 10.7%

- Laryngeal penetration: 14.3%

- Aspiration: 14.3%

- Effective cough reflex: 39.3%

- Velopharyngeal competence: 67.9%

The authors claim FEES as the examination of choice in swallowing safety