A comparison of esophageal screening approaches in videofluoroscopic swallowing studies

What is it about?

Videofluoroscopic swallowing studies (VFSS) are detailed assessments of the oral and pharyngeal aspects of swallowing and are led by speech-language pathologists (SLPs). However, viewing the whole swallow system (mouth to stomach) in VFSS is critical due to the known co-occurrence of pharyngeal and esophageal disorders. Brief visualization of the esophagus in VFSS is referred to as esophageal screening. Esophageal screening can identify possible esophageal abnormalities, direct referrals to gastroenterology for diagnostic assessment, and assist SLPs in choosing appropriate treatments for swallowing difficulties (dysphagia). This study compared two different approaches to esophageal screening at one Australian hospital: clinician-led versus a protocol. The operational and clinical benefits and challenges of each esophageal screening approach were explored.

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Photo by Sigmund on Unsplash

Photo by Sigmund on Unsplash

Why is it important?

While esophageal screening is within SLPs scope of practice and considered a valuable inclusion in VFSS, recent international surveys of clinicians indicate that routine standardized esophageal screening is not widely occurring. This study showed that the introduction of an esophageal screening protocol at the research site increased uniformity and rates of esophageal screening and increased the number of patients identified with possible esophageal abnormalities. However, this study highlighted that the interpretation, reporting and clinical utilization of esophageal screening results remains challenging. Further research with the multidisciplinary dysphagia team is needed to continue to refine esophageal screening, improve clinician competence and confidence, and optimize patient dysphagia outcomes.