By GI Motility - upper (oesophagus and stomach)Leave a Comment on Videofluoroscopy

Video fluoroscopy is a noninvasive procedure that uses X-rays to create real-time images of the mouth and throat during swallowing. Video fluoroscopy can help to evaluate the anatomy and function of the swallowing mechanism, identify the causes and consequences of dysphagia (difficulty swallowing), and determine the appropriate interventions and recommendations.

Feasibility/Equipment: Video fluoroscopy requires a fluoroscopy unit, a video recorder, a monitor, and a radiologist or a technician to operate the equipment. Specific training is required to guarantee correct testing and interpretation. The patient needs to be able to participate and actively swallow in order to perform the test.

Scoring information: Video fluoroscopy does not have a standardized scoring system, but various scales and measures have been proposed to quantify and classify the findings.

Some examples of these scales and measures are:

  • The Penetration–Aspiration Scale (PAS), which rates the depth and response of material entering the airway on an 8-point scale [1].
  • The Modified Barium Swallow Impairment Profile (MBSImP), which assesses 17 components of swallowing physiology on a 3-point scale [2].
  • The Dysphagia Outcome and Severity Scale (DOSS), which assigns a level of dysphagia severity and functional oral intake based on clinical and instrumental findings [3].

Cost: Video fluoroscopy is considered a relatively expensive procedure, as it involves the use of specialized equipment, personnel, and materials. The estimated cost of video fluoroscopy varies depending on the setting, duration, and complexity of the test, but it can range from $200 to $1000 per study [4].

Evidence: Video fluoroscopy is regarded as the gold standard for diagnosing oropharyngeal dysphagia, as it provides detailed information on the anatomy and physiology of swallowing, as well as the presence and severity of aspiration [5] [6]. Video fluoroscopy can also help to guide the management of dysphagia, such as recommending dietary modifications, compensatory strategies, or rehabilitation exercises [5] [6]. However, video fluoroscopy has some limitations, such as radiation exposure, limited availability, poor ecological validity, and inter-rater variability [7] [8]. Additionally, it is not well validated in the setting of critical care medicine.

Accuracy / measurement properties: Video fluoroscopy has high accuracy and reliability for detecting aspiration and other swallowing abnormalities, compared to other methods such as clinical examination or endoscopic evaluation [7] [8]. Video fluoroscopy has also been shown to correlate with other outcomes in critically ill patients, such as pneumonia incidence, length of hospital stay, mortality rate, and quality of life [9] [10].

Some specific data for video fluoroscopy outcomes are:

  • Sensitivity: 88%–100%, specificity: 50%–100% for aspiration detection [7] [98].
  • Inter-rater reliability: 0.61–0.98 for PAS scores [1].
  • Predictive value: 67%–100% for pneumonia development [9] [10].

References:

  1. Rosenbek JC, Robbins JA, Roecker EB, Coyle JL, Wood JL. A penetration-aspiration scale. Dysphagia. 1996;11(2):93–8. https://link.springer.com/article/10.1007/BF00417897
  2. Martin-Harris B, Brodsky MB, Michel Y, Castell DO, Schleicher M, Sandidge J, et al. MBS measurement tool for swallow impairment—MBSImp: establishing a standard. Dysphagia. 2008;23(4):392–405. https://link.springer.com/article/10.1007/s00455-008-9185-9
  3. O’Neil KH, Purdy M, Falk J, Gallo L. The dysphagia outcome and severity scale. Dysphagia. 1999;14(3):139–45. https://link.springer.com/article/10.1007/PL00009595
  4. How Much Does a Modified Barium Swallow Cost Near Me? – MDsave [Internet]. [cited 2023 Aug 15]. Available from: https://www.mdsave.com/procedures/modified-barium-swallow-mbs/d584facb
  5. Speyer R, Baijens L, Heijnen M, Zwijnenberg I. Effects of therapy in oropharyngeal dysphagia by speech and language therapists: a systematic review. Dysphagia. 2010;25(1):40–65. https://link.springer.com/article/10.1007/s00455-009-9239-1
  6. Langmore SE. Evaluation of oropharyngeal dysphagia: which diagnostic tool is superior? Curr Opin Otolaryngol Head Neck Surg. 2003;11(6):485–9. https://journals.lww.com/co-otolaryngology/Abstract/2003/12000/Evaluation_of_oropharyngeal_dysphagia__which.15.aspx
  7. Aviv JE, Kaplan ST, Thomson JE, Spitzer J, Diamond B, Close LG. The safety of flexible endoscopic evaluation of swallowing with sensory testing (FEESST): an analysis of 500 consecutive evaluations. Dysphagia. 2000;15(1):39–44. 10.1007/s004559910008
  8. Dejaeger E, Pelemans W, Ponette E, Joosten E. Mechanisms involved in postdeglutition retention in the elderly. Dysphagia. 1997;12(2):63–7. https://link.springer.com/article/10.1007/PL00009516
  9. Marik PE, Kaplan D. Aspiration pneumonia and dysphagia in the elderly. Chest. 2003;124(1):328–36. 10.1378/chest.124.1.328
  10. Hinchey JA, Shephard T, Furie K, Smith D, Wang D, Tonn S. Formal dysphagia screening protocols prevent pneumonia. Stroke. 2005;36(9):1972–6. https://www.ahajournals.org/doi/full/10.1161/01.str.0000177529.86868.8d

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