Aspiration in the Fiberoptic Endoscopic Evaluation of Swallowing Associated with an Increased Risk of Mortality in a Cohort of Patients Suspected of Oropharyngeal Dysphagia

Dysphagia. 2020 Apr;35(2):369-377. doi: 10.1007/s00455-019-10036-7. Epub 2019 Jul 20.


There is a general lack of published studies on the risk of mortality due to alterations in the safety of swallowing detected during the fiberoptic endoscopic evaluation of swallowing (FEES). We aimed at assessing the risk of mortality of the detection of aspiration, penetration, and pharyngeal residues by FEES. A cohort of consecutively evaluated patients suspected of experiencing oropharyngeal dysphagia undergoing FEES at a tertiary care university hospital were prospectively followed up on to assess mortality. The FEES findings, comorbidities, and potential confounders were studied as predictors of death using a Cox multivariate regression analysis. A total of 148 patients were included, 85 of whom were male (57.4%). The mean age (± standard deviation) was 52.7 years (± 22.1). The median of the follow-up time was 4.5 years. The most frequent conditions were stroke in 50 patients (33.8%), brain and spine traumas in 27 (18.2%), and neurodegenerative diseases in 19 (12.8%). Variables associated with mortality in bivariate analyses were age > 65 years (p < 0.001), pneumonia (p = 0.046), aspiration of any consistency (p < 0.001), and pharyngeal residues (p = 0.017). Variables independently associated with mortality in the Cox multivariate model were age (> 65 years) [adjusted hazard ratio (HR) 5.76; 95% CI 2.72 to 17.19; p = 0.001] and aspiration (adjusted HR: 3.96; 95% CI 1.82 to 14.64; p = 0.003). Aspiration detected by FEES and an age > 65 years are independent predictors of mortality in patients with oropharyngeal dysphagia.

Keywords: Deglutition; Deglutition disorders; Dysphagia; Fiberoptic endoscopic evaluation of swallowing (FEES); Mortality; Respiratory aspiration; Swallowing.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Age Factors
  • Aged
  • Deglutition / physiology
  • Deglutition Disorders / complications
  • Deglutition Disorders / diagnostic imaging
  • Deglutition Disorders / mortality*
  • Endoscopy, Digestive System / methods
  • Endoscopy, Digestive System / statistics & numerical data*
  • Female
  • Fiber Optic Technology / methods
  • Fiber Optic Technology / statistics & numerical data*
  • Humans
  • Male
  • Middle Aged
  • Optical Fibers
  • Predictive Value of Tests
  • Proportional Hazards Models
  • Prospective Studies
  • Respiratory Aspiration / diagnostic imaging
  • Respiratory Aspiration / etiology
  • Respiratory Aspiration / mortality*
  • Risk Assessment
  • Risk Factors