Helliwell K, Hughes V J, Bennion C M, Manning-Stanley A
Calderdale and Huddersfield NHS Foundation Trust, Calderdale Royal Hospital, Salterhebble, Halifax, HX3 0PW, UK.
Department of Diagnostic Radiography, School of Health Sciences, University of Liverpool, Johnston Building, Brownlow Hill, L69 3GB, UK.
Radiography (Lond). 2023 Mar;29(2):284-290. doi: 10.1016/j.radi.2022.12.007. Epub 2023 Jan 12.
Patients with suspected acute stroke require rapid assessment of swallowing on admission. If aspiration is suspected, this takes the form of specialist assessment, using either videofluoroscopy (VFS) or fibreoptic endoscopic evaluation of swallowing (FEES). The review aim was to evaluate and compare the effectiveness of each method in stroke patients. Literature was collected from the databases Scopus, Web of Science and Medline, and articles included in the review were published within the last 10 years, in the English language.
Sensitivity and specificity ranged from 0.29-0.33 and 0.96-1.0 for VFS, respectively, and 0.37-1.0 and 0.65-0.87 for FEES, respectively, depending on the type of bolus utilised. VFS is the current gold-standard for the investigation of oropharyngeal dysphagia (OD), however, radiation dose and patient transport implications mean FEES may be preferred. FEES has limitations including 'whiteout' and the invasive nature of the endoscope. The NICE guidelines do not recommend a definitive protocol specifically in stroke patients. This suggests further research may be required to determine the most effective method.
FEES is a beneficial first line examination, providing limited invasiveness, and administering a high level of patient suitability, without using ionising radiation. VFS could potentially be useful following FEES to secure full visualisation, ensuring an aspiration event is not missed during FEES.
Use of FEES as the first line test rather than VFS, ensures radiation dose is as low as reasonably practicable (ALARP). Ongoing research to ensure protocols follow current best practice can help ensure accurate management of oropharyngeal dysphagia in stroke patients.
疑似急性中风患者入院时需要迅速评估吞咽功能。若怀疑有误吸情况，则需采用专科评估，可使用电视荧光吞咽造影检查（VFS）或纤维内镜吞咽功能评估（FEES）。本综述旨在评估并比较这两种方法对中风患者的有效性。从Scopus、科学网和Medline数据库收集文献，纳入综述的文章为过去10年内发表的英文文献。
根据所使用的食团类型，VFS的敏感性和特异性分别为0.29 - 0.33和0.96 - 1.0，FEES的敏感性和特异性分别为0.37 - 1.0和0.65 - 0.87。VFS是目前口咽吞咽困难（OD）检查的金标准，然而，辐射剂量和患者转运问题意味着FEES可能更受青睐。FEES存在局限性，包括“白色视野”和内镜的侵入性。英国国家卫生与临床优化研究所（NICE）指南并未特别针对中风患者推荐明确的方案。这表明可能需要进一步研究以确定最有效的方法。
FEES是一种有益的一线检查方法，侵入性有限，患者适用性高，且不使用电离辐射。在FEES之后使用VFS可能有助于实现全面可视化，确保在FEES期间不会漏诊误吸事件。
将FEES用作一线检查而非VFS，可确保辐射剂量尽可能低至合理可行水平（ALARP）。持续开展研究以确保方案遵循当前最佳实践，有助于确保准确管理中风患者的口咽吞咽困难。
