The safety of flexible endoscopic evaluation of swallowing with sensory testing (FEESST): An analysis of 500 consecutive evaluations

We assessed the safety of a new office or bedside method of evaluating both the motor and sensory components of swallowing called flexible endoscopic evaluation of swallowing with sensory testing (FEESST). FEESST combines the established endoscopic evaluation of swallowing with a technique that dete rmines laryngopharyngeal sensory discrimination thresholds by endoscopicall y delivering air-pulse stimuli to the mucosa innervated by the superior lar yngeal nerve. Endoscopic assessment of laryngopharyngeal sensory capacity f ollowed by endoscopic visualization of deglutition was prospectively perfor med 500 times in 253 patients with dysphagia over a 2.5-year period in a te rtiary care center. The patients had a variety of underlying diagnoses, wit h stroke and chronic neurological disease predominating (n = 155). To deter mine the safety of FEESST, the presence of epistaxis, airway compromise, an d significant changes in heart rate before and after the evaluation were as sessed. Patients were also asked to rate the level of discomfort of the exa mination; 498 evaluations were completed. There were three instances of epi staxis that were self-limited. There were no cases of airway compromise. Th ere were no significant differences in heart rate between pre- and posttest measurements (p > 0.05). Eighty-one percent of patients noted either no di scomfort or mild discomfort as a result of the examination. In conclusion, FEESST is a safe method of evaluating dysphagia in the tertiary care settin g and may also have application for the chronic care setting.