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-

  • 1The National Evidence-based Healthcare Collaborating Agency, Center for New Health Technology Assessment, Korea.
  • 2Department of Otolaryngology-Head and Neck Surgery, School of Medicine, The Catholic University of Korea, Korea.
  • 3Yonsei Rehabilitation Clinic, Korea.
  • 4Department of Otolaryngology-Head and Neck Surgery, Kyung Hee University School of Medicine, Korea.
  • 5Division of Gastroenterology, Department of Internal Medicine, School of Medicine, The Catholic University of Korea, Korea.
  • 6Department of Physical and Rehabilitation Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Korea.


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.
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.
FEES is considered as a safe and effective test in patients with dyspahgia and grade C evidence based on existing studies.


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