Videoendoscopy worsens swallowing function: a videofluoroscopic study. A randomized controlled trial.

Abstract

Aspiration pneumonia is a cause of mortality in the elderly. Evaluating swallowing function is important. Videofluoroscopy and flexible endoscopic evaluation of swallowing are comparable; however, observing all swallowing dynamics is impossible using the latter approach. We examined the significance of flexible endoscopic evaluation of swallowing using videofluoroscopy. Thirty-seven patients with dysphagia [70.0±8.9 (range 49-84)years] were included. In random order, patients underwent videofluoroscopy with 10cc contrast material, once without, and once with an endoscope inserted. Laryngeal elevation delay time, Penetration-Aspiration Scale score, and Pharyngeal Residue Severity Rating Scale score were evaluated. Laryngeal elevation delay time without or with endoscope insertion was similar (0.35±0.16s vs. 0.36±0.16s, P=0.29). The Penetration-Aspiration Scale (3.59±2.71 vs. 4.41±2.85; P<0.001) and Pharyngeal Residue Severity Rating Scale (0.97±0.93 vs. 1.46±1.10; P<0.001) scores differed significantly. The cases that showed no aspiration without endoscope insertion showed greater aspiration with endoscope insertion, and the cases that did not show aspiration with an endoscope inserted also showed no aspiration without an endoscope. Flexible endoscopic insertion resulted in more severe aspiration and residue than non-insertion, as assessed using videofluoroscopy.