Fiberoptic Endoscopic Evaluation of Swallowing (FEES) in Pediatrics: A Systematic Review

International Journal of Pediatric Otorhinolaryngology

Pizzorni, N., Rocca, S., et al. (2024).

International Journal of Pediatric Otorhinolaryngology, 181, 111983.

<div>This systematic review investigates the feasibility, safety, and accuracy of fiberoptic endoscopic evaluation of swallowing (FEES) in children (i.e., individuals under the age of 18).&nbsp;</div>

No funding received

2000 to September 15, 2023

<div>Original studies with full texts excluding conference proceeding, theses, editorials, and protocols</div>

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<div>FIndings regarding feasibility for FEES in pediatric populations included:</div> <div> <ul> <li><strong>Endoscope insertion: </strong>There was high feasibility (i.e., 89% to 100%) in 33 of 34 studies.</li> <li><strong>Assessing swallow function: </strong>Feasibility ranged from 40% to 100%, with the lowest feasibility reported in newborns due to breastfeeding-related difficulties.&nbsp;</li> <li><strong>Bolus</strong> <strong>trials:</strong> Feasibility ranged from 66% to 100% in infants aged 12 months or under and from 52.4% to 100% across all pediatric age groups (i.e., birth to 18 years).</li> <li><strong>Reasons for reduced feasibility: </strong>Rationales for terminating FEES studies included hypertonia, lack of compliance/tolerance, increased heart rate, physical resistance, excessive crying, food refusal, ineffective bolus extraction, excess of pharyngeal secretions, anatomical restrictions, and influence of underlying conditions.</li> </ul> <div>Limitations to this review included unreported data, heterogeneity between studies, and inclusion of low quality studies.&nbsp;</div> </div>

<div>Nine studies, including six studies conducted in neonatal intensive care units, reported no complications.</div> <div>&nbsp;</div> <div>The most frequently reported complications of FEES in children included:</div> <div> <ul> <li>excessive crying (8 studies);</li> <li>irritability/agitation (4 studies);</li> <li>transient oxygen desaturations under 85% (1.2%-6.7% of patients in 3 studies);</li> <li>epistaxis (0.8%-3.3% of patients across 3 studies);</li> <li>increased heart rate (1 patient);</li> <li>vomiting (1 patient);</li> <li>hypertonia (1 study); and</li> <li>hypersalivation (1 study).</li> </ul> <div>Limitations to this review included unreported data, heterogeneity between studies, and inclusion of low quality studies.</div> </div>

<div>Eight studies investigated the diagnostic accuracy of FEES for pediatric patients. Findings included:</div> <div> <ul> <li>Agreement between FEES and videofluoroscopic swallow studies (VFSS) ranged from 10% to 100%. However, the majority of these studies did not perform FEES and VFSS simultaneously.&nbsp;</li> <li>When compared to VFSS, FEES was less sensitive and more specific for aspiration (sensitivity = 25%-94%; specificity = 75%-100%) and pharyngeal residue (sensitivity = 40%-67%; specificity = 70%-94%). FEES was more sensitivity and less specific for penetration (sensitivity = 76%-100%; specificity = 44-83%).&nbsp;</li> <li>When compared to laryngeal ultrasound, FEES had an agreement of &gt;95% between signs of pharyngeal dysphagia and a reduction of&nbsp;<span style="text-decoration: underline;">&lt;</span>40% of laryngeal excursion for children with neurological disorders.&nbsp;</li> <li>When compared to clinical swallow exams (CSEs), FEES results generally agreed with CSE findings in 94.5% to 93.7% of cases.</li> <li>Inter-rate agreement of FEES ranged from 66.7% to 100%.&nbsp;&nbsp;</li> </ul> </div> <div>Limitations to this review included unreported data, heterogeneity between studies, and inclusion of low quality studies.</div>