{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,18]],"date-time":"2026-07-18T03:28:13Z","timestamp":1784345293196,"version":"3.55.0"},"reference-count":13,"publisher":"Wiley","issue":"10","license":[{"start":{"date-parts":[[2018,6,22]],"date-time":"2018-06-22T00:00:00Z","timestamp":1529625600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"funder":[{"DOI":"10.13039\/501100003710","name":"Korea Health Industry Development Institute","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100003710","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Euro J of Neurology"],"published-print":{"date-parts":[[2018,10]]},"abstract":"<jats:sec><jats:title>Background and purpose<\/jats:title><jats:p>Diagnosis of pharyngeal dysphagia caused by myasthenia gravis (<jats:styled-content style=\"fixed-case\">MG<\/jats:styled-content>) based on clinical examination alone is often challenging. Flexible endoscopic evaluation of swallowing (<jats:styled-content style=\"fixed-case\">FEES<\/jats:styled-content>) combined with Tensilon (edrophonium) application, referred to as the <jats:styled-content style=\"fixed-case\">FEES<\/jats:styled-content>\u2010Tensilon test, was developed to improve diagnostic accuracy and to detect the main symptoms of pharyngeal dysphagia in <jats:styled-content style=\"fixed-case\">MG<\/jats:styled-content>. Here we investigated inter\u2010 and intra\u2010rater reliability of the <jats:styled-content style=\"fixed-case\">FEES<\/jats:styled-content>\u2010Tensilon test and analyzed the main endoscopic findings.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Four experienced raters reviewed a total of 20 <jats:styled-content style=\"fixed-case\">FEES<\/jats:styled-content>\u2010Tensilon test videos in randomized order. Residue severity was graded at four different pharyngeal spaces before and after Tensilon administration. All interpretations were performed twice per rater, 4 weeks apart (a total of 160 scorings). Intra\u2010rater test\u2013retest reliability and inter\u2010rater reliability levels were calculated.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>The most frequent <jats:styled-content style=\"fixed-case\">FEES<\/jats:styled-content> findings in patients with <jats:styled-content style=\"fixed-case\">MG<\/jats:styled-content> before Tensilon application were prominent residues of semi\u2010solids spread all over the hypopharynx in varying locations. The reliability level of the interpretation of the <jats:styled-content style=\"fixed-case\">FEES<\/jats:styled-content>\u2010Tensilon test was excellent regardless of the rater's profession or years of experience with <jats:styled-content style=\"fixed-case\">FEES<\/jats:styled-content>. All four raters showed high inter\u2010 and intra\u2010reliability levels in interpreting the <jats:styled-content style=\"fixed-case\">FEES<\/jats:styled-content>\u2010Tensilon test based on residue clearance (kappa = 0.922, 0.981). The degree of residue normalization in the vallecular space after Tensilon application showed the highest inter\u2010 and intra\u2010rater reliability level (kappa = 0.863, 0.957) followed by the epiglottis (kappa = 0.813, 0.946) and pyriform sinuses (kappa = 0.836, 0.929).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Interpretation of the <jats:styled-content style=\"fixed-case\">FEES<\/jats:styled-content>\u2010Tensilon test based on residue severity and degree of Tensilon clearance, especially in the vallecular space, is consistent and reliable.<\/jats:p><\/jats:sec>","DOI":"10.1111\/ene.13688","type":"journal-article","created":{"date-parts":[[2018,5,26]],"date-time":"2018-05-26T08:15:40Z","timestamp":1527322540000},"page":"1235-1242","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":17,"title":["Reliability and main findings of the flexible endoscopic evaluation of swallowing\u2010Tensilon test in patients with myasthenia gravis and dysphagia"],"prefix":"10.1111","volume":"25","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8400-4911","authenticated-orcid":false,"given":"S.","family":"Im","sequence":"first","affiliation":[{"name":"Department of Rehabilitation Medicine Bucheon St Mary's Hospital College of Medicine The Catholic University of Korea Bucheonshi Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"S.","family":"Suntrup\u2010Krueger","sequence":"additional","affiliation":[{"name":"Department of Neurology University of M\u00fcnster M\u00fcnster Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"S.","family":"Colbow","sequence":"additional","affiliation":[{"name":"Department of Neurology University of M\u00fcnster M\u00fcnster Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"S.","family":"Sauer","sequence":"additional","affiliation":[{"name":"Department of Neurology University of M\u00fcnster M\u00fcnster Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"I.","family":"Claus","sequence":"additional","affiliation":[{"name":"Department of Neurology University of M\u00fcnster M\u00fcnster Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"S. G.","family":"Meuth","sequence":"additional","affiliation":[{"name":"Department of Neurology University of M\u00fcnster M\u00fcnster Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"R.","family":"Dziewas","sequence":"additional","affiliation":[{"name":"Department of Neurology University of M\u00fcnster M\u00fcnster Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"T.","family":"Warnecke","sequence":"additional","affiliation":[{"name":"Department of Neurology University of M\u00fcnster M\u00fcnster Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2018,6,22]]},"reference":[{"key":"e_1_2_8_2_1","doi-asserted-by":"publisher","DOI":"10.1002\/mus.20030"},{"key":"e_1_2_8_3_1","doi-asserted-by":"publisher","DOI":"10.1016\/S1388-2457(01)00546-6"},{"key":"e_1_2_8_4_1","doi-asserted-by":"publisher","DOI":"10.1136\/jnnp.2004.038430"},{"key":"e_1_2_8_5_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00415-008-0664-6"},{"key":"e_1_2_8_6_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00455-015-9631-4"},{"key":"e_1_2_8_7_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jclinepi.2010.03.002"},{"key":"e_1_2_8_8_1","doi-asserted-by":"publisher","DOI":"10.1177\/001316447303300309"},{"key":"e_1_2_8_9_1","doi-asserted-by":"publisher","DOI":"10.2307\/2529310"},{"key":"e_1_2_8_10_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.parkreldis.2016.04.034"},{"key":"e_1_2_8_11_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00455-001-0114-4"},{"key":"e_1_2_8_12_1","doi-asserted-by":"publisher","DOI":"10.1097\/01.cnd.0000211411.17317.31"},{"key":"e_1_2_8_13_1","doi-asserted-by":"publisher","DOI":"10.1259\/0007-1285-35-409-43"},{"key":"e_1_2_8_14_1","doi-asserted-by":"publisher","DOI":"10.1055\/s-2003-40755"}],"container-title":["European Journal of Neurology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/api.wiley.com\/onlinelibrary\/tdm\/v1\/articles\/10.1111%2Fene.13688","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/ene.13688","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1111\/ene.13688","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/ene.13688","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,8,29]],"date-time":"2023-08-29T18:19:38Z","timestamp":1693333178000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/ene.13688"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2018,6,22]]},"references-count":13,"journal-issue":{"issue":"10","published-print":{"date-parts":[[2018,10]]}},"alternative-id":["10.1111\/ene.13688"],"URL":"https:\/\/doi.org\/10.1111\/ene.13688","archive":["Portico"],"relation":{},"ISSN":["1351-5101","1468-1331"],"issn-type":[{"value":"1351-5101","type":"print"},{"value":"1468-1331","type":"electronic"}],"subject":[],"published":{"date-parts":[[2018,6,22]]},"assertion":[{"value":"2017-12-25","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2018-05-22","order":1,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2018-06-22","order":2,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}