Eyes on swallowing: New FEES program allows direct visualization

The Saint Joseph NICU recently launched a program that enables a fiberoptic endoscopic evaluation of swallowing for babies who are struggling and at risk of aspiration. Known as a FEES technology, it allows physicians to visualize swallowing mechanics directly through a camera, rather than via x-ray with barium dye, as with the video fluoroscopic swallow study already available.

The images below show the difference between FEES technology, at left, and VFSS technology, at right.

Both tests have their benefits. VFSS is not limited by camera location and can provide information about oral coordination and sucking strength, esophageal stricture and reflux. It also can be combined with other studies in radiology.

Another factor in determining the preferred study is the baby’s level of agitation and potential intolerance of the FEES exam, which requires the insertion of a camera into the baby’s nose.

Depending on the identifiable symptoms and a variety of factors, babies might benefit more from FEES, VFSS or a combination of both.

As for the benefits of FEES, “This new test offers clear visualization of the vocal cords and larynx, allowing us to evaluate for anatomic abnormalities or evidence of subtle swallow dysfunction more readily,” said Amber Messier-Gieri, MD, Neonatal-Perinatal Medicine. “In comparison to VFSS, the babies avoid radiation exposure, they don’t need to be moved for a test that can be performed in their rooms, and it’s much easier to schedule, which means we get the results faster.”

Once it’s determined a FEES test is needed, speech and occupational therapists are called to the patient room to insert a camera through the baby’s nose and project the captured image onto a screen. A dye is added to the formula to best visualize the liquid’s path. Swallowing mechanics then are directly observed during a bottle feed, revealing even the most subtle mechanic and anatomical issues.

Remedies can be as simple as thickening the baby’s formula or as advanced as corrective surgery.

The FEES program launched in April. Since then, about five babies per month have been identified as good candidates for a FEES swallowing evaluation: They demonstrated an observable, uncoordinated swallow, such as choking, or had other symptoms of an abnormality, such as an inability to consume enough liquid per feeding.

“We have an exceptional, progressive team in the NICU that is always looking to advance the care we provide babies,” said Messier-Gieri. “Major university medical centers across the country offer FEES to their babies, and now we do, too.”

Messier-Gieri hopes that in the next six months, the team will be able to provide FEES studies to breastfeeding babies, which is not possible during a VFSS study.

Physicians with questions about FEES or VFSS can contact Messier-Gieri via email.