Bina Tariq1, Sorina R Simon2,3,4, Walmari Pilz2,5, Andra Maxim2, Bernd Kremer2,3, Laura W J Baijens2,3. 1. Department of Otorhinolaryngology, Head and Neck Surgery, Maastricht University Medical Center, Maastricht, The Netherlands. bina.tariq@outlook.com. 2. Department of Otorhinolaryngology, Head and Neck Surgery, Maastricht University Medical Center, Maastricht, The Netherlands. 3. School for Oncology and Developmental Biology, GROW, Maastricht University, Maastricht, The Netherlands. 4. Department of Radiology and Nuclear Medicine, Maastricht University Medical Center, Maastricht, The Netherlands. 5. School for Mental Health and Neuroscience, MHeNs, Maastricht University, Maastricht, The Netherlands.
Abstract
OBJECTIVE: Methylene blue (MB) is frequently administered during fiberoptic endoscopic evaluation of swallowing (FEES) to enhance visualization of pharyngeal bolus transit. However, the safety of MB is being questioned since serious adverse events (AEs) such as hemodynamic instability, hemolysis, and serotonin syndrome were reported. The aim of this study is a systematic analysis of the literature to obtain an evidence-based overview of AEs due to oral administration of MB and to determine its safety as a food dye during swallowing assessment. METHODS: A systematic literature search was carried out in PubMed, Embase, and Cochrane Library. Two reviewers independently selected articles describing oral administration of MB as a main diagnostic/therapeutic intervention, dosage, and AEs. Expert opinions, conference papers, sample size < 10, and animal studies were excluded. Level of evidence of the included studies was determined. RESULTS: A total of 2264 unduplicated articles were obtained. Seventeen studies met the inclusion criteria with 100% agreement between the two reviewers. Among these, twelve studies were randomized controlled trials. In a pooled population of 1902 patients receiving oral MB, three serious AEs were reported related to MB. Non-serious AEs showed a dose-related trend and were usually mild and self-limiting. A meta-analysis could not be performed as studies were methodologically too heterogeneous. CONCLUSION: Serious AEs due to oral administration of MB are rare (n = 3, 0.16%). MB-related non-serious AEs are mild, self-limiting, and show a dose-related trend. These findings indicate that it is safe to use small amounts of MB as a food dye during swallowing examinations.
OBJECTIVE:Methylene blue (MB) is frequently administered during fiberoptic endoscopic evaluation of swallowing (FEES) to enhance visualization of pharyngeal bolus transit. However, the safety of MB is being questioned since serious adverse events (AEs) such as hemodynamic instability, hemolysis, and serotonin syndrome were reported. The aim of this study is a systematic analysis of the literature to obtain an evidence-based overview of AEs due to oral administration of MB and to determine its safety as a food dye during swallowing assessment. METHODS: A systematic literature search was carried out in PubMed, Embase, and Cochrane Library. Two reviewers independently selected articles describing oral administration of MB as a main diagnostic/therapeutic intervention, dosage, and AEs. Expert opinions, conference papers, sample size < 10, and animal studies were excluded. Level of evidence of the included studies was determined. RESULTS: A total of 2264 unduplicated articles were obtained. Seventeen studies met the inclusion criteria with 100% agreement between the two reviewers. Among these, twelve studies were randomized controlled trials. In a pooled population of 1902 patients receiving oral MB, three serious AEs were reported related to MB. Non-serious AEs showed a dose-related trend and were usually mild and self-limiting. A meta-analysis could not be performed as studies were methodologically too heterogeneous. CONCLUSION: Serious AEs due to oral administration of MB are rare (n = 3, 0.16%). MB-related non-serious AEs are mild, self-limiting, and show a dose-related trend. These findings indicate that it is safe to use small amounts of MB as a food dye during swallowing examinations.
Authors: Serge Gauthier; Howard H Feldman; Lon S Schneider; Gordon K Wilcock; Giovanni B Frisoni; Jiri H Hardlund; Hans J Moebius; Peter Bentham; Karin A Kook; Damon J Wischik; Bjoern O Schelter; Charles S Davis; Roger T Staff; Luc Bracoud; Kohkan Shamsi; John M D Storey; Charles R Harrington; Claude M Wischik Journal: Lancet Date: 2016-11-16 Impact factor: 79.321
Authors: Michael J Telch; Aleksandra K Bruchey; David Rosenfield; Adam R Cobb; Jasper Smits; Sandra Pahl; F Gonzalez-Lima Journal: Am J Psychiatry Date: 2014-10 Impact factor: 18.112
Authors: Martin Alda; Margaret McKinnon; Ryan Blagdon; Julie Garnham; Susan MacLellan; Claire O'Donovan; Tomas Hajek; Cynthia Nair; Serdar Dursun; Glenda MacQueen Journal: Br J Psychiatry Date: 2016-06-09 Impact factor: 9.319
Authors: Walmari Pilz; Sophie Vanbelle; Bernd Kremer; Michel R van Hooren; Tine van Becelaere; Nel Roodenburg; Laura W J Baijens Journal: Dysphagia Date: 2016-01-23 Impact factor: 3.438