Evaluation of swallowing safety with fiberoptic endoscope: comparison with videofluoroscopic technique

Laryngoscope. 1997 Mar;107(3):396-401. doi: 10.1097/00005537-199703000-00023.


Videofluoroscopy has long been viewed as the "gold standard" of swallowing examination for the comprehensive information it provides. However, it is not very efficient and accessible in some practical situations. In this study, we tried to use a modified technique of fiberoptic endoscopic examination of swallowing (FEES) in evaluating dysphagic patients. For each examination, a spoonful of pudding and dyed water were fed in sequence three times. The pharyngeal swallowing events were observed with fiberscope panoramically and videotaped. Twenty-eight chronic dysphagic patients underwent both videofluoroscopy and FEES in 2 weeks. Comparison of the results revealed that disagreements in premature oral leakage to the pharynx, pharyngeal stasis, laryngeal penetration, aspiration, effective cough reflex, and velopharyngeal incompetence were 39.3%, 10.7%, 14.3%, 14.3%, 39.3%, and 32.1%, respectively. FEES was found to be more sensitive in detecting these risky features of swallowing, except with respect to premature leakage. Possible causes of the discrepant results are discussed, and the limitation of videofluoroscopy in practical usage is discussed. FEES is conclusively a safer, more efficient, and sensitive method than videofluoroscopy in evaluating swallowing safety.

Publication types

  • Comparative Study

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Chronic Disease
  • Coloring Agents
  • Cough / etiology
  • Deglutition / physiology*
  • Deglutition Disorders / diagnosis
  • Deglutition Disorders / diagnostic imaging
  • Deglutition Disorders / physiopathology
  • Endoscopes*
  • Evaluation Studies as Topic
  • Female
  • Fiber Optic Technology / instrumentation
  • Fluoroscopy
  • Food
  • Foreign Bodies / etiology
  • Gagging / physiology
  • Humans
  • Larynx / physiopathology
  • Male
  • Middle Aged
  • Mouth / physiopathology
  • Pharynx / physiopathology
  • Safety
  • Sensitivity and Specificity
  • Trachea
  • Velopharyngeal Insufficiency / physiopathology
  • Videotape Recording


  • Coloring Agents