A systematic review of water-soluble contrast use in videofluoroscopic examination of dysphagia

Abstract

Introduction: The Videofluoroscopic Swallow Study (VFSS) is a key diagnostic tool for evaluating swallowing function, providing dynamic visualization of bolus transit and swallowing mechanism. Traditionally, barium is used as the contrast medium due to its effectiveness in highlighting anatomical and functional aspects of swallowing. However, water-soluble contrast (WSC) agents, which differ in osmolarity, viscosity, and iodine atom-particle ratio, have emerged as alternatives and their optimal use in VFSS remains unclear. This systematic review investigates the utilization of WSC agents in VFSS.

Materials and methods: This systematic review was conducted following the PRISMA 2020 guidelines, extensively analyzing WSC agents use in VFSS. Searches were conducted across PubMed, Scopus, and Google Scholar using keywords "Water-Soluble Contrast, Videofluoroscopic, High-Osmolar Water-Soluble Contrast, and/or Low-Osmolar Water-Soluble Contrast". A total of 574 papers were initially identified.

Results: Nine studies (2013-2021) investigated the use of WSC agents in VFSS. The studies varied in methodology and WSC agents used, with no standardized protocols identified. Findings indicated that low-osmolar WSCs may reduce the risk of complications, such as aspiration and pulmonary edema, compared to barium sulfate. WSC agents were utilized in high-risk populations, such as those with head and neck surgeries or neurological conditions.

Conclusion: WSC agents may serve as a viable alternative to barium sulfate in VFSS, particularly for high-risk patients. However, further research is needed to compare their diagnostic accuracy, patient outcomes, and safety profiles, as well as to establish standardized protocols for their use in dysphagia evaluation.