Brain Neurorehabil.  2013 Mar;6(1):9-16. 10.12786/bn.2013.6.1.9.

Effectiveness of Fiberoptic Endoscopic Evaluation of Swallowing (FEES) in Patients with Swallowing Disorders -A Systematic Review-

• Lee WS
• Lee SH
• Park YH
• Lee JW
• Kwon KH
• Kim SW
• Kim YH

• KMID: 2270734
• DOI: http://doi.org/10.12786/bn.2013.6.1.9

Abstract

OBJECTIVE
The objective of this systematic review is to evaluate the safety and effectiveness of fiberoptic endoscopic evaluation of swallowing (FEES) for dysphagia patients. METHOD: We performed a systematic review of the literature. We searched Ovid-Medline(R), EMBASE(R) and Cochrane library(R) and Eight domestic databases including KoreaMed up to 19 April 2010. In addition, we added hand search. Searches were conducted without language restriction. We identified ten studies that met our eligibility criteria. Two reviewers independently extracted prespecified data from each study. Also reviewers assessed quality of each study. The qualities of these studies were assessed according to Scottish Intercollegiate Guidelines Network (SIGN) tool.
RESULTS
Ten studies (nine diagnostic evaluation studies and one case series) were identified. The complication rate of FEES was 6% which was reported only one study as nose bleeding that did not need further treatment. The effectiveness of FEES was evaluated based on diagnostic accuracy, agreement rate with videofluoroscopy as a reference test. The sensitivities of FEES were 0.87~1.0 (penetration), 0.22~0.96 (aspiration), 0.68~0.91 (pharyngeal residue), and 0.75 (premature spillage) respectively. Specificities of FEES were 0.75~1.0 (penetration), 0.88~1.0 (aspiration), 0.86~1.0 (pharyngeal residue), and 0.56 (premature spillage) respectively. Agreement rate with VFFS were 85~100% (penetration), 82.3~100% (aspiration), 80~89.3% (pharyngeal residues), and 60.7% (premature spillage) respectively. There was no evidence of statistical heterogeneity. The body of evidence as a whole suggests a grade C for FEES.
CONCLUSION
FEES is considered as a safe and effective test in patients with dyspahgia and grade C evidence based on existing studies.

Keyword

fiberoptic endoscopic evaluation of swallowing; swallowing disorder; systematic review; videofluoroscopy

MeSH Terms

Deglutition
Deglutition Disorders
Epistaxis
Fees and Charges
Hand
Humans
Population Characteristics

Figure

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  Fig. 1 Flow diagram for inclusion and exclusion of selected studies.

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  Fig. 2 Forest plot of sensitivities and specificities in penetration.

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  Fig. 3 Receiver operating characteristics (ROC) curve of penetration in FEES.

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  Fig. 4 Forest plot of sensitivities and specificities in aspiration.

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  Fig. 5 Receiver operating characteristics (ROC) curve of aspiration in FEES.

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