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Lee, Lee, Park, Lee, Kwon, Kim, and Kim: Effectiveness of Fiberoptic Endoscopic Evaluation of Swallowing (FEES) in Patients with Swallowing Disorders -A Systematic Review-
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Brain & Neurorehabilitation

Brain & Neurorehabilitation 2013; 6(1): 9-16.

Published online: 29 March 2013

DOI: https://doi.org/10.12786/bn.2013.6.1.9

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

Worl-Sook Lee, M.P.H., Seon-Heui Lee, Ph.D., Young Hak Park, M.D., Ph.D.1, Jae Whan Lee, M.D., Ph.D.2, Kee Hwan Kwon, M.D., Ph.D.3, Sang Woo Kim, M.D., Ph.D.4, Yun-Hee Kim, M.D., Ph.D.5

The National Evidence-based Healthcare Collaborating Agency, Center for New Health Technology Assessment, Korea.

1Department of Otolaryngology-Head and Neck Surgery, School of Medicine, The Catholic University of Korea, Korea.

2Yonsei Rehabilitation Clinic, Korea.

3Department of Otolaryngology-Head and Neck Surgery, Kyung Hee University School of Medicine, Korea.

4Division of Gastroenterology, Department of Internal Medicine, School of Medicine, The Catholic University of Korea, Korea.

5Department of Physical and Rehabilitation Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Korea.

Corresponding author (yunkim@skku.edu)

Copyright © 2013 Korean Society for Neurorehabilitation

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®, EMBASE® and Cochrane library® 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.

Keywords: fiberoptic endoscopic evaluation of swallowing, swallowing disorder, systematic review, videofluoroscopy

Figures and Tables

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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Table 1
Levels of Evidence
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Table 2
Grades of Recommendation
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Table 3
Selected Studies
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*VFSS: Video Fluoroscopy Swallowing Study.

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