The role of the endoscopist in the stroke unit

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 strokeassociated 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.