What Is FEES?

Fiberoptic Endoscopic Evaluation of Swallowing (FEES) is a well-established technique that has revolutionized the field of dysphagia diagnostics. FEES is a sensitive, accurate, portable, and safe examination that yields clinically useful information relative to swallowing physiology and swallowing safety. The procedure involves passing a flexible endoscope across the floor of a patient’s nasal passage into the pharynx so that the larynx, pharynx and upper esophageal opening are viewed directly from above. Then the patient is administered food or liquids mixed with food coloring in order to determine safe swallowing function and integrity. FEES can be done at the patient’s bedside, in an office, intensive care unit or in a long-term care facility in under 20 minutes with regular food and liquids. Since there is absolutely no radiation administered the studies are able to be sustained for longer time intervals, allowing the clinicians the ability to tell if a patient’s swallowing technique is impacted by fatigue.

How does FEES compare with MBSS?

FEES has repeatedly demonstrated a sensitivity equal to or greater than MBSS in determining whether a patient is exhibiting penetration, aspiration, delay in swallowing initiation and pharyngeal residue. Additionally, FEES provides visualizations of pharyngeal secretions that cannot be detected during MBSS.

•             No need to coordinate time with radiology department schedule

•             No radiation exposure with FEES

•             No unpleasant barium-tainted food & no barium-associated constipation for patients

•             No waiting to be cleared from isolation precautions

•             FEES can be used with patients on mechanical ventilation

•             Normal food is given to patients

•             FEES can be performed while a patient is sitting upright or in bed

•             FEES can be performed easily on morbidly obese patients as opposed to MBSS

•             FEES can be given to medically complex patients who otherwise would not tolerate a trip to radiology

•             Physician does not have to be present during a FEES study

•             FEES is shown in High Definition digital color as both a still and video

•             The use of the term “gold standard” as applied to MBSS is no longer appropriate

•             Videotape recording of endoscopies objectively discovers and documents details that cannot be appreciated by the unaided eye in real-time

•             There may be cost advantages associated with FEES versus MBSS for the inpatient management of dysphagia

How Long has FEES Been utilized to diagnose swallowing disorders?

Susan Langmore, Ph.D., and coworkers coined the term FEES in 1986 and published the first data demonstrating the effectiveness of the procedure in 1988. It is also known by a few other names such as “video endoscopic evaluation of dysphagia” and “bedside endoscopic swallowing test”. Typically this procedure falls within the scope of practice of speech-language pathology.


What other options exist to diagnose swallowing disorders?

The Modified Barium Swallow Study (MBSS), also known as video-fluoroscopic swallow study, is a common, older procedure for the assessment of dysphagia. It is performed in the video-fluoroscopy suite in a hospital involving a radiologist, a radiology technologist and a speech-language pathologist. The patient must be seated in an upright position and fed barium coated food while being x-rayed. The MBSS study is time limited in order to reduce radiation exposure for the patient. The time limitation doesn’t allow for impact of fatigue on a patient’s ability to swallow effectively. Food and liquid consistencies are simulated through the use of liquid barium and barium pastes.

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