Name of the Procedure:

Flexible Endoscopic Evaluation of Swallowing (FEES) by Cine or Video Recording

Summary

Flexible Endoscopic Evaluation of Swallowing by cine or video recording is a diagnostic procedure that uses a flexible endoscope to visualize and record the swallowing process. This helps in identifying swallowing disorders.

Purpose

The procedure aims to diagnose swallowing disorders by observing the swallowing mechanism in real-time. This aids in identifying issues such as aspiration, penetration, or other abnormalities in the oropharyngeal stage of swallowing.

Indications

• Dysphagia (difficulty swallowing)
• Frequent coughing or choking while eating
• Unexplained weight loss
• Recurrent pneumonia
• Neurological conditions affecting swallowing

Preparation

• Fasting for at least 2 hours before the procedure
• Informing the healthcare provider about any medications or allergies
• Possible pre-procedure diagnostic tests such as a modified barium swallow study or a speech-language pathology assessment

Procedure Description

1. The patient is seated comfortably, usually in an outpatient clinic.
2. Topical anesthesia may be applied to the nasal passage to ease the insertion of the endoscope.
3. A flexible endoscope is gently inserted through one nostril and positioned to visualize the throat.
4. The patient is asked to eat and drink various consistencies of food and liquid.
5. The swallowing process is observed and digitally recorded from multiple angles.
6. The healthcare provider reviews and analyzes the video recordings to assess swallowing function and diagnose any disorders.

Duration

The procedure typically lasts between 20 to 30 minutes.

Setting

The procedure is usually performed in an outpatient clinic or a specialized endoscopy suite within a hospital.

Personnel

• A speech-language pathologist
• An otolaryngologist (ENT specialist)
• A nurse or medical assistant may also be present

Risks and Complications

• Mild discomfort or gagging during the procedure
• Nosebleed
• Rarely, aspiration or respiratory distress
• Infection, though extremely uncommon

Benefits

• Precise diagnosis of swallowing disorders
• Identification of appropriate treatments or dietary modifications
• Real-time visualization of swallowing dynamics
• Immediate feedback and care planning

Recovery

• Minor discomfort may occur, but typically resolves quickly
• Normal activities can usually be resumed immediately after the procedure
• Follow-up consultations may be recommended based on findings

Alternatives

• Modified Barium Swallow Study (MBSS): Radiographic visualization of swallowing
  • Pros: Detailed anatomical view
  • Cons: Exposure to radiation
• Clinical swallowing assessment by a speech-language pathologist
  • Pros: Non-invasive, no equipment needed
  • Cons: Less detailed than FEES

Patient Experience

• The patient may feel slight pressure or discomfort as the endoscope is inserted.
• Topical anesthetic can minimize discomfort but may cause a temporary numb sensation.
• Swallowing different consistencies can be unusual but is generally not painful.
• Post-procedure, the patient might experience mild throat irritation, which typically resolves within a few hours.