Videofluoroscopic Swallow Study and Fiberoptic Endoscopic Evaluation of Swallow—Which Is Superior?

by CM Lawlor, MD, and Sukgi S. Choi, MD, MBA •

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BACKGROUND

The prevalence of pediatric dysphagia is on the rise as more children with prematurity and complex medical conditions survive infancy. Accurate assessment of the safety of oral feeds is essential in the pediatric population to avoid the risks of unsafe feeding or unnecessary restrictions. Instrumental swallow assessments, including video fluoroscopic swallow studies (VFSS) and fiberoptic endoscopic evaluation of swallow (FEES), are complimentary to clinical feeding evaluations.

VFSS and FEES analyze swallowing biomechanics and the safety of swallow with various modifications (including means of food delivery, consistencies of food, and maneuvers), and may be able to identify the etiology of dysphagia (Dysphagia. 2022;37:1183–1200). In adults, VFSS and FEES have shown high rates of agreement in the diagnosis of penetration and aspiration. Small studies have aimed to assess the parity of these exams in children (Int J Pediatr Otorhinolaryngol. 2020;138:110339).

BEST PRACTICE

Though there is substantial agreement between VFSS and FEES in adults, this has not borne out in small studies in children to date. The preponderance of evidence to date suggests poor-to-moderate agreement between pediatric VFSS and FEES in the assessment of penetration and aspiration.

FEES may have lower sensitivity and accuracy for diagnosis of aspiration; thus, it may not be the first choice exam when the decision for oral feeding is guarded. Alternatively, when a baby is exclusively breastfed, FEES may be the preferred exam. VFSS and FEES may be used in compliment, as FEES allows for direct exam of the upper aerodigestive tract. Both VFSS and FEES may not be available at every institution; thus, otolaryngologists may be limited in their choice of instrumental study.