Name of the Procedure:

Flexible endoscopic evaluation of swallowing (FEES) by cine or video recording; interpretation and report only.

Summary

Flexible endoscopic evaluation of swallowing (FEES) is a procedure that uses a thin, flexible tube with a camera on the end (endoscope) to visually examine the swallowing process. The procedure is recorded on video for later analysis and interpretation to diagnose swallowing disorders.

Purpose

• Medical condition addressed: FEES is used to evaluate swallowing difficulties (dysphagia).
• Goals and outcomes: The aim is to identify abnormalities in the swallowing mechanism, determine the safest dietary recommendations, and guide treatment strategies.

Indications

• Symptoms/conditions: Chronic cough, frequent choking, unexplained weight loss, pneumonia or respiratory issues related to swallowing problems.
• Patient criteria: Individuals experiencing symptoms of dysphagia, especially those with neurological conditions, head and neck cancers, or post-surgical changes.

Preparation

• Pre-procedure instructions: Patients may be asked to fast for a few hours prior to the procedure.
• Diagnostics: A comprehensive review of the patient's medical history and symptoms. No specific tests are generally required, but previous imaging or swallowing studies might be reviewed.

Procedure Description

• Step-by-step:
  1. A topical anesthetic is applied to the nose and throat.
  2. The endoscope is gently inserted through the nasal passage and positioned just above the vocal cords.
  3. The patient is given different food textures and liquids to swallow.
  4. The swallowing process is recorded for analysis.
• Tools/equipment: Flexible endoscope, video recording equipment, food and liquids of varying consistencies.
• Anesthesia/sedation: Typically, only a topical anesthetic is used; sedation is not required.

Duration

The procedure typically takes about 20 to 30 minutes.

Setting

FEES is usually performed in an outpatient clinic, hospital, or specialized swallowing disorder center.

Personnel

• Healthcare professionals: The procedure is often conducted by a speech-language pathologist (SLP) with specialized training in FEES, sometimes assisted by a nurse or a medical assistant.

Risks and Complications

• Common risks: Mild discomfort or gagging, nosebleeds, slight sore throat.
• Rare complications: Laryngospasm, vasovagal response, or, very rarely, more significant bleeding.
• Management: Most complications are minor and resolve quickly. Severe complications are managed according to medical protocols.

Benefits

• Expected benefits: Accurate diagnosis of swallowing disorders, better management and treatment plan tailored to individual needs.
• Realization: Benefits are often apparent immediately through tailored dietary adjustments and interventions.

Recovery

• Post-procedure care: Usually, no special care is required post-procedure. Patients can resume normal activities and diet unless otherwise advised.
• Recovery time: Recovery is immediate; any minor discomfort typically resolves within a few hours.
• Follow-up: A follow-up appointment may be scheduled to discuss findings and treatment options.

Alternatives

• Other options: Barium swallow study, Modified Barium Swallow (MBS), Videofluoroscopic Swallow Study (VFSS).
• Pros and cons:
  • MBS/VFSS: Provides a more detailed view of the entire swallowing process but involves exposure to radiation.
  • FEES: No radiation exposure, provides direct visualization of the throat, but may be less comfortable.

Patient Experience

• During the procedure: Patients might feel mild discomfort from the endoscope and experience slight nasal irritation or gagging.
• After the procedure: Temporary sore throat or nasal discomfort may occur. Pain is usually minimal and can be managed with over-the-counter medications if necessary.
• Comfort measures: Gentle technique, use of topical anesthetics, and providing reassurance and support throughout the procedure.