Risks and Benefits

All instrumental procedures carry some risk. FEES has a very low risk of complications.   

• The most common complication is nose-bleeding (epistaxis). This has been reported to occur in up to 1.2% of assessments. Other complications include vasovagal episodes (fainting) in up to 0.1%, and laryngospasm (involuntary closing of the vocal cords) in up to 0.07%.    Reference: Langmore, S.E. History of Fiberoptic Endoscopic Evaluation of Swallowing for Evaluation and Management of Pharyngeal Dysphagia: Changes over the Years. Dysphagia 32, 27–38 (2017). https://doi.org/10.1007/s00455-016-9775-x     

The benefits of FEES include:  

• Correct identification of swallowing impairments, aspiration, and residue. Non-instrumental assessment of swallowing can incorrectly identify dysphagia due to silent aspiration which is when aspiration occurs but there is no cough in response.
• Identification of the safest food and fluid consistencies in one assessment, reducing the risk of aspiration or avoiding the need for unnecessary modification of fluids or foods if this has previously been recommended. This can save money by reducing the need for special food or thickened fluids or multiple non-clinical swallowing assessments. Reference: Braun T, Juenemann M, Viard M, et al What is the value of fibre-endoscopic evaluation of swallowing (FEES) in neurological patients? A cross-sectional hospital-based registry study.BMJ Open 2018; 8:e019016. doi: 10.1136/ https://bmjopen.bmj.com/content/8/3/e019016  
• Improved understanding of the swallowing difficulties by watching the assessment and keeping a copy of the video.  
• Identification of ways to make swallowing easier and safer to avoid pneumonia and weight loss/malnutrition.