Related Experiment Video
Updated: Jun 25, 2025
Guidelines for Elective Pediatric Fiberoptic Intubation
Published on: January 17, 2011
Fiberoptic endoscopic evaluation of swallowing (FEES) in pediatrics: A systematic review
Nicole Pizzorni1, Sara Rocca1, Angelo Eplite2
1Department of Biomedical and Clinical Sciences, Università degli Studi di Milano, Milan, 20157, Italy.
Insights
Fiberoptic endoscopic evaluation of swallowing (FEES) is a safe and feasible procedure for pediatric patients with swallowing difficulties. However, standardized protocols for FEES in children are needed for consistent clinical practice and research.
Area of Science:
- Pediatric Medicine
- Otolaryngology
- Speech-Language Pathology
Background:
- Dysphagia is a common concern in pediatric populations, impacting nutrition and development.
- Fiberoptic endoscopic evaluation of swallowing (FEES) offers a minimally invasive method for assessing swallowing function.
- Standardized protocols and comprehensive data on FEES in children are essential for its optimal application.
Approach:
- A systematic review was conducted, searching four electronic databases and performing a hand-search of references.
- Data from 81 studies involving pediatric patients were extracted, focusing on feasibility, safety, diagnostic accuracy, and protocols.
- Study quality was assessed using Johanna Briggs Institute checklists, with data extraction and appraisal performed by two independent researchers.
Key Points:
- FEES demonstrated high feasibility for endoscope insertion (89%-100%) but variable feasibility for bolus trials (40%-100%).
- Adverse events were generally mild, including crying, irritability, and transient oxygen desaturations; no major complications were reported.
- FEES showed varying sensitivity and specificity for aspiration and penetration compared to videofluoroscopic swallow studies (VFSS), with heterogeneous protocols hindering direct comparisons.
Conclusions:
- FEES is a safe, accurate, and generally feasible examination for pediatric patients with suspected dysphagia.
- Significant heterogeneity in FEES protocols and reporting exists, highlighting the need for a consensus to guide clinical practice and research.
- Further research is warranted to establish standardized FEES protocols for pediatric populations.
Objectives:
The systematic review aimed to provide an overview of the state-of-art regarding the use of fiberoptic endoscopic evaluation of swallowing (FEES) in pediatrics, specifically investigating FEES feasibility, safety, diagnostic accuracy, and protocols.
Methods:
Four electronic databases were searched for original studies on the pediatric population that instrumentally assessed swallowing function using FEES. A hand-search of the references of included studies was performed. Data on the population, feasibility of endoscope insertion and bolus trials, adverse events, sensitivity and specificity, and FEES equipment and protocol were extracted. The quality of the studies was assessed using the checklists of the Johanna Briggs Institute. Selection of the studies, data extraction, and quality appraisal were conducted by two independent researchers.
Results:
Eighty-two reports from 81 studies were included. The mean overall quality of the studies was 80 % (17-100 %). The feasibility of endoscope insertion was high (89%-100 %), while the feasibility of bolus trials varied from 40 % to 100 %. Adverse events were excessive crying (8 studies), irritability or agitation (4 studies), transitory oxygen desaturations (3 studies, 1.2-6.7 % of the patients), epistaxis (3 studies, 0.8-3.3 % of the patients), increased heart rate (1 study, 1 patient), vomiting (1 study, 1 patient), hypertonia (1 study), and hypersalivation (1 study). No major complications were reported. Using VFSS as the reference standard, FEES was generally found to be less sensitive (25-94 %) but more specific (75-100 %) for aspiration, whereas the reverse was true for penetration (sensitivity 76-100 %, specificity 44-83 %). FEES protocols were highly heterogeneous with poor reporting.
Conclusion:
FEES is a safe, accurate, and generally feasible examination in the pediatric population with suspected dysphagia. However, a consensus on the best FEES protocol for clinical practice and research is currently lacking.
More Related Videos
08:32Adapting Human Videofluoroscopic Swallow Study Methods to Detect and Characterize Dysphagia in Murine Disease Models
Published on: March 1, 2015
07:22Minimally Invasive Murine Laryngoscopy for Close-Up Imaging of Laryngeal Motion During Breathing and Swallowing
Published on: December 1, 2023
Related Concept Videos
01:25Ultrasound II: Endoscopic Ultrasound and FibroScan
Endoscopic Ultrasound (EUS):
01:29Endoscopic Procedures I: Esophagogastroduodenoscopy
During an EGD, the endoscope can be used to:
01:26Esophageal Strictures-II: Clinical Features and Management
Healthcare providers should gather a comprehensive medical history and conduct a physical examination for diagnosis. If esophageal stricture is...
01:26Endoscopic Procedures V: ERCP
Patient...
01:30Endoscopic Studies I: Bronchoscopy and Thoracoscopy
Bronchoscopy
Description
Bronchoscopy is a procedure that involves direct visualization of the larynx, trachea, and bronchi for diagnostic and therapeutic purposes. A flexible fiber optic or rigid bronchoscope is used to carry out the procedure. The fiber-optic bronchoscope is more frequently used due...
01:24Upper GI Series: Barium Swallow
Purpose and Procedure
Patients undergoing this procedure ingest a liquid containing barium sulfate with a chalky...