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Narrow Band Imaging Enhances the Detection Rate of Penetration and Aspiration in FEES

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Abstract

Narrow band imaging (NBI) is widely used in gastrointestinal, laryngeal, and urological endoscopy. Its original purpose was to visualize vessels and epithelial irregularities. Based on our observation that adding NBI to common white light (WL) improves the contrast of the test bolus in fiberoptic endoscopic evaluation of swallowing (FEES), we now investigated the potential value of NBI in swallowing disorders. 148 FEES images were analyzed from 74 consecutive patients with swallowing disorders, including 74 with and 74 without NBI. All images were evaluated by four dysphagia specialists. Findings were classified according to Rosenbek’s penetration-aspiration scale modified for evaluating these FEES images. Intra- and inter-rater reliability was determined as well as observer confidence. A better visualization of the bolus is the main advantage of NBI in FEES. This generally leads to sharper optical contrasts and better detection of small bolus quantities. Accordingly, NBI enhances the detection rate of penetration and aspiration. On average, identification of laryngeal penetration increased from 40 to 73% and of aspiration from 13 to 24% (each p < 0.01) of patients. In contrast to WL alone, the use of NBI also markedly increased the inter- and intra-rater reliability (p < 0.01) and the rating confidence of all experts (p < 0.05). NBI is an easy and cost-effective tool simplifying dysphagia evaluation and shortening FEES evaluation time. It leads to a markedly higher detection rate of pathological findings. The significantly better intra- and inter-rater reliability argues further for a better overall reproducibly of FEES interpretation.

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References

  1. Langmore SE, Schatz K, Olsen N. Fiberoptic endoscopic examination of swallowing safety: a new procedure. Dysphagia. 1988;2(4):216–9.

    Article  CAS  PubMed  Google Scholar 

  2. Langmore SE, Schatz K, Olson N. Endoscopic and videofluoroscopic evaluations of swallowing and aspiration. Ann Otol Rhinol Laryngol. 1991;100(8):678–81.

    Article  CAS  PubMed  Google Scholar 

  3. Colodny N. Interjudge and intrajudge reliabilities in fiberoptic endoscopic evaluation of swallowing (fees) using the penetration-aspiration scale: a replication study. Dysphagia. 2002;17(4):308–15. doi:10.1007/s00455-002-0073-4.

    Article  PubMed  Google Scholar 

  4. Deutschmann MW, McDonough A, Dort JC, Dort E, Nakoneshny S, Matthews TW. Fiber-optic endoscopic evaluation of swallowing (FEES): predictor of swallowing-related complications in the head and neck cancer population. Head Neck. 2013;35(7):974–9. doi:10.1002/hed.23066.

    Article  PubMed  Google Scholar 

  5. Leder SB, Sasaki CT, Burrell MI. Fiberoptic endoscopic evaluation of dysphagia to identify silent aspiration. Dysphagia. 1998;13(1):19–21. doi:10.1007/PL00009544.

    Article  CAS  PubMed  Google Scholar 

  6. Kelly AM, Drinnan MJ, Leslie P. Assessing penetration and aspiration: how do videofluoroscopy and fiberoptic endoscopic evaluation of swallowing compare? Laryngoscope. 2007;117(10):1723–7. doi:10.1097/MLG.0b013e318123ee6a.

    Article  PubMed  Google Scholar 

  7. Rosenbek JC, Robbins JA, Roecker EB, Coyle JL, Wood JL. A penetration-aspiration scale. Dysphagia. 1996;11(2):93–8.

    Article  CAS  PubMed  Google Scholar 

  8. Rosen CA, Amin MR, Sulica L, Simpson CB, Merati AL, Courey MS, Johns MM 3rd, Postma GN. Advances in office-based diagnosis and treatment in laryngology. Laryngoscope. 2009;119(Suppl 2):S185–212. doi:10.1002/lary.20712.

    Article  PubMed  Google Scholar 

  9. Yoshida T, Inoue H, Usui S, Satodate H, Fukami N, Kudo SE. Narrow-band imaging system with magnifying endoscopy for superficial esophageal lesions. Gastrointest Endosc. 2004;59(2):288–95. doi:10.1016/S0016-5107(03)02532-X.

    Article  PubMed  Google Scholar 

  10. Watanabe A, Tsujie H, Taniguchi M, Hosokawa M, Fujita M, Sasaki S. Laryngoscopic detection of pharyngeal carcinoma in situ with narrowband imaging. Laryngoscope. 2006;116(4):650–4. doi:10.1097/01.mlg.0000204304.38797.34.

    Article  PubMed  Google Scholar 

  11. Piazza C, Dessouky O, Peretti G, Cocco D, De Benedetto L, Nicolai P. Narrow-band imaging: a new tool for evaluation of head and neck squamous cell carcinomas. Review of the literature. Acta Otorhinolaryngol Ital. 2008;28(2):49–54.

    CAS  PubMed  PubMed Central  Google Scholar 

  12. Arens C, Betz C, Kraft M, Voigt-Zimmermann S. Narrow band imaging for early diagnosis of epithelial dysplasias and microinvasive tumors in the upper aerodigestive tract. HNO. 2016;64(1):19–26. doi:10.1007/s00106-015-0108-4.

    Article  CAS  PubMed  Google Scholar 

  13. Muto M, Nakane M, Katada C, Sano Y, Ohtsu A, Esumi H, Ebihara S, Yoshida S. Squamous cell carcinoma in situ at oropharyngeal and hypopharyngeal mucosal sites. Cancer. 2004;101(6):1375–81. doi:10.1002/cncr.20482.

    Article  PubMed  Google Scholar 

  14. Landis JR, Koch GG. The measurement of observer agreement for categorical data. Biometrics. 1977;33(1):159–74.

    Article  CAS  PubMed  Google Scholar 

  15. Hey C, Pluschinski P, Pajunk R, Almahameed A, Girth L, Sader R, Stover T, Zaretsky Y. Penetration-aspiration: is their detection in FEES (R) reliable without video recording? Dysphagia. 2015;30(4):418–22. doi:10.1007/s00455-015-9616-3.

    Article  PubMed  Google Scholar 

  16. Langmore SE. Endoscopic evaluation and treatment of swallowing disorders. 2nd ed. New York: Thieme Verlag; 2000.

    Google Scholar 

  17. Gallivan GJ. FEES/FEESST and videotape recording: there’s more to this than meets the eye. Chest. 2002;122(5):1513–5.

    Article  PubMed  Google Scholar 

  18. Dziewas R, Glahn J, Helfer C, Ickenstein G, Keller J, Ledl C, Lindner-Pfleghar B, Nabavi D, Prosiegel M, Riecker A, Lapa S, Stanschus S, Warnecke T, Busse O. Flexible endoscopic evaluation of swallowing (FEES) for neurogenic dysphagia: training curriculum of the German Society of Neurology and the German stroke society. BMC Med Educ. 2016;16:70. doi:10.1186/s12909-016-0587-3.

    Article  PubMed  PubMed Central  Google Scholar 

  19. Vu A, Farah CS. Narrow band imaging: clinical applications in oral and oropharyngeal cancer. Oral Dis. 2016;22(5):383–90. doi:10.1111/odi.12430.

    Article  CAS  PubMed  Google Scholar 

  20. Wu CH, Hsiao TY, Chen JC, Chang YC, Lee SY. Evaluation of swallowing safety with fiberoptic endoscope: comparison with videofluoroscopic technique. Laryngoscope. 1997;107(3):396–401.

    Article  CAS  PubMed  Google Scholar 

  21. Onofri SM, Cola PC, Berti LC, da Silva RG, Dantas RO. Correlation between laryngeal sensitivity and penetration/aspiration after stroke. Dysphagia. 2014;29(2):256–61. doi:10.1007/s00455-013-9504-7.

    Article  PubMed  Google Scholar 

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    Authors and Affiliations

    1. Department of Voice, Speech and Hearing Disorders, Center for Clinical Neurosciences, University Medical Center Hamburg-Eppendorf, Hamburg, Germany

      Julie C. Nienstedt, Frank Müller, Almut Nießen, Susanne Fleischer, Jana-Christiane Koseki, Till Flügel & Christina Pflug

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    1. Julie C. Nienstedt
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    2. Frank Müller
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    3. Almut Nießen
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    4. Susanne Fleischer
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    5. Jana-Christiane Koseki
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    6. Till Flügel
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    7. Christina Pflug
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    Correspondence to Christina Pflug.

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    The study was conducted in compliance with the Helsinki Declaration.

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    Julie C. Nienstedt and Christina Pflug have equally contributed on this work.

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    Nienstedt, J.C., Müller, F., Nießen, A. et al. Narrow Band Imaging Enhances the Detection Rate of Penetration and Aspiration in FEES. Dysphagia 32, 443–448 (2017). https://doi.org/10.1007/s00455-017-9784-4

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