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Researchers Develop Consensus Statements on Use of Swallowing Fluoroscopy in Adults Best Practices

by Linda Kossoff •

What are the best practices to guide clinical use of swallowing fluoroscopy in adults that would reduce practice variation, and how could the quality of care for patients suffering from swallowing impairment be improved?

BOTTOM LINE

Researchers arrived at 40 statements pertaining to the comprehensive use of swallowing fluoroscopy in adults that can guide best practices and influence policy regarding the procedure.

BACKGROUND: Despite the extensive use of swallowing fluoroscopy as the gold standard in investigating deglutitive disorders, there is currently no uniformly accepted practice for the procedure in the United States. Because of this, there has been a wide array of standards, protocols, and interpretative strategies in use.

STUDY DESIGN: Literature review.

SETTING: Department of Otolaryngology–Head and Neck Surgery, University of Texas Southwestern Medical Center, Dallas, Texas.

SYNOPSIS: In seeking consensus on best practices for the use of swallowing fluoroscopy, American Broncho-Esophagological Association (ABEA) leaders enlisted the help of specialists within their organization, such as otolaryngologists with broncho-esophagology proficiency, radiologists, and speech language pathologists in clinical practice. Studies were collected via a multi-database query of relevant terms. A total of 264 publications were included in the team’s review, and a modified Delphi protocol was used to create consensus statements that would ultimately meet the criteria. The resulting 40 statements encompassed patient selection, fluoroscopic study choice, radiation safety, clinical team dynamics, training requirements, videofluoroscopic swallow study (VFSS) and esophagram techniques, and swallowing fluoroscopy interpretation. Among the statements were that VFSS should follow a standardized and reproducible stepwise protocol that includes the lateral and anterior-posterior views, and that SPLs should have specific training and competency in performing and interpreting VFSS. The 40 statements, say authors, can guide the development of best practices for the use of swallowing fluoroscopy in adults. They add, however, that lack of consensus on certain aspects of esophagram technique may reflect gaps in knowledge and clinical practice variation, warranting future research.

CITATION: Dhar SI, Nativ-Zeltzer N, Starmer H, et al. The American Broncho-Esophagological Association position statement on swallowing fluoroscopy. Laryngoscope. 2023;133:255–268.