The American Broncho-Esophagological Association Position Statement on Swallowing Fluoroscopy
Laryngoscope
Dhar, S. I., Nativ-Zeltzer, N., et al. (2023).
Laryngoscope, 133(2), 255-268.
This guideline provides recommendations on the clinical use of swallowing fluoroscopy in adults with swallowing impairment. This summary highlights recommendations within the scope of speech-language pathology.
American Broncho-Esophagological Association
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<div>Adults with swallowing impairments can benefit from swallowing fluoroscopy as part of the swallowing diagnostic evaluation, particularly for at-risk populations such as patients with head and neck cancer, prolonged intubation, failure to thrive, or neurological abnormalities (B).</div>
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<li>Swallowing fluoroscopy may also be appropriate in evaluating patients with globus pharyngeus, chronic cough, regurgitation/pyrosis, or recurrent pneumonia (B).</li>
<li>Videofluoroscopic swallow studies (VFSS) are appropriate for patients with suspected swallowing impairments from the oral to the pharyngoesophageal phases of deglutition or patients with inconclusive or incongruent clinical swallow exam results (C).</li>
<li>VFSS should be the assessment tool used for patients with known neurologic diseases or with liquid dysphagia complaints (A).</li>
<li>For vulnerable populations (e.g., pregnant women, women of reproductive age), alternative diagnostic testing should be considered to avoid unnecessary radiation exposure (D).</li>
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"Swallowing fluoroscopy should be conducted by a trained team which includes radiologic technologists, speech-language pathologists (SLP), and a fluoroscopy supervisor depending on government regulations" (D; p. 258). "Speech-language pathologists should have specific training and competency in performing and interpreting [videofluoroscopic swallow study] VFSS" (D; p. 258).
When conducting a videofluoroscopic swallow study (VFSS), clinicians should follow "a standardized and reproducible stepwise protocol including the lateral and anterior-posterior (AP) views" (B; p. 258) and adhere to radiation safety protocols (D). As clinically appropriate, VFSS protocol should progress from the smallest bolus volume to larger volumes and multiple consistencies and solids should be used (B). "It is at the discretion of the SLP and/or swallowing clinician to weigh the risk of harm of contrast aspiration against obtaining quality swallowing data that could eventually lead to improved assessment and health of the patient" (B; p. 258). VFSS should assess compensatory maneuvers, texture modifications, diet allocation, and efficacy of rehabilitative strategies (B) and may also be used to monitor recovery or functional decline in patients with known swallowing impairment (D). VFSS should include an esophageal screen if a comprehensive esophagram is not conducted (B).
When interpreting and reporting on fluoroscopy results, the technique used for the procedure (e.g., contrast type, consistency, position, patient limitations), study components (e.g., airway invasion and response, maneuvers and postures attempted, swallowing components), and dietary recommendations and treatment plan should be described (B). When it occurs, premature termination of a study should be noted and should include the reason for discontinuing the assessment (B).
