The utility of the FEES in the early diagnosis of dysphagia and nutrition decisions in post-stroke patients

Dysphagia is one of the most common complications of stroke. The decision about forms of nutrition for post-stroke patients (PSPs) should be taken during hospitalization. Evaluation of dysphagia is possible by fiberoptic endoscopic evaluation of swallowing (FEES). This study aimed to assess the cause and frequency of dysphagia in PSPs and the effectiveness of FEES in nutrition decisions to prevent complications.

This cross-sectional study was conducted in 29 adult PSPs of the neurological Unit in tertiary hospital. The FEES examination was done after giving three different types of food boluses, starting with semisolid, then liquid, and finally solid textures. The results were recorded and analyzed using scales: Daniels' test and the Penetration–Aspiration Scale (PAS).

The mean age of subjects was 67 years (26-83). Nerve palsy VII was found in five patients, nerve palsy XII – in two. The patients were classified into three groups: residue at vallecula and/or pyriformis sinus (n=12,41.38%; PAS level 8), penetration only (n=7,24.14%; PAS level 2-4) and penetration with aspiration (n=10,34.38%; PAS level 5-8). FEES examination was done mean 2-7 days after stroke. 15 subjects used nasogastric tube (NGT) during examination, and started with feeding rehabilitation.

After FEES assessment further feeding decision was done: in 5 patients NGT removal, 3 were qualified to PEG. FEES examination plays a crucial role in recommendations for feeding in PSPs. A major task for the future is to develop an algorithm for feeding decisions of PSPs.

The authors declare that there is no conflict of interest.