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Review
. 2016 Feb;32(1):53-7.
doi: 10.1159/000443656. Epub 2016 Feb 2.

The Role of the Endoscopist in the Stroke Unit

Thomas Frieling  1
Affiliations
Review

The Role of the Endoscopist in the Stroke Unit

Thomas Frieling. Visc Med. 2016 Feb.

Abstract

Background: Acute cerebral stroke is a common problem that is frequently associated with dysphagia resulting in an increased risk of aspiration pneumonia, complication, and mortality.

Methods: A literature review was carried out using the search terms 'stroke unit and endoscopy', 'stroke unit and dysphagia', and 'stroke unit and gastroenterology'.

Results: Only few papers focus on the role of endoscopy in stroke units. One major role is the early detection of dysphagia by flexible endoscopic evaluation of swallowing (FEES). FEES appears to have a higher sensitivity and specificity compared to bedside tests and challenges videofluoroscopy. In contrast, other stroke-associated gastrointestinal complications requiring endoscopic diagnostic or therapeutic intervention, such as gastrointestinal bleeding, abdominal pain, or stasis, and the need to provide fluid and food via gastrostomy or jejunostomy are rarely seen in stroke units and become relevant during and after the rehabilitation phase.

Conclusion: FEES should involve an interdisciplinary team comprising neurologists, speech and language pathologists and/or therapists, as well as gastroenterologic endoscopists.

Keywords: Acute stroke; Dysphagia; Endoscopy Aspiration; Gastrostomy tube feeding; Stroke unit.

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Figures

Fig. 1
Fig. 1
Consequences of acute cerebral stroke. Occurrence of dysphagia significantly increases the risk of pneumonia [8,10].
Fig. 2
Fig. 2
Oropharyngeal dysphagia following acute stroke. Nasal videoendoscopy shows residual of mucous within both sinus piriformes (left) and predominantly within the right sinus piriformis (right).
Fig. 3
Fig. 3
Algorithm of dysphagia screening in stroke units adopted and modified from [24,25,26]. KSA = Evaluation of medical history for swallowing; KSU = clinical swallowing assessment.
See this image and copyright information in PMC

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