The Role of the SLP in the Performance & Interpretation of Endoscopic Evaluation of Swallowing: Position Statement. (ASHA website):


Knowledge and Skills for SLPs Performing Endoscopic Assessment of Swallowing Functions (ASHA website):


The History of FEES

Langmore, S.E. History of Fiberoptic Endoscopic Evaluation of Swallowing for Evaluation and Management of Pharyngeal Dysphagia:
Changes over the Years. Dysphagia. (2017) 32: 27.

The Safety of FEES

FEES is extremely safe and well-tolerated when performed by a trained medical SLP. The incidence of complications associated with FEES is less than 1%.

  • Aviv, J.E., Kaplan, S.T., Thompson, J.E., Spitzer, J., Diamond, B., & Close, L.G. (2000).  The safety of flexible endoscopic evaluation of swallowing with sensory testing (FEEST): An analysis of 500 consecutive evaluations. Dysphagia, 15(1), 39-44.
  • Aviv, J.E., Murray, T., Zschommler, A., Cohen, M., & Gartner, C. (2005). Flexible endoscopic evaluation of swallowing with sensory testing: Patient characteristics and analysis of safety in 1,340 consecutive examinations.  Annals of Otology, Rhinology & Laryngology. 114, 173-176.
  • Cohen, M.A., Setzen, M., Perlman, P.W., Ditkoff, M., Mattucci, K.F., & Guss, J. (2003).  The safety of flexible endoscopic evaluation of swallowing with sensory testing in an outpatient otolaryngology setting.  The Laryngoscope. 113(1), 21-24.

Benefits of FEES

  • Higher in sensitivity to pharyngeal residue than a Modified Barium Swallow Study (MBSS)
  • No radiation exposure
  • No need to transport fragile patients to radiology appointments
  • Easily performed on bariatric patients and medically complex patients
  • Performed at patient’s bedside, or location of choice, and in patient’s natural eating position
  • Appropriate for patients on mechanical ventilation
  • Physician’s presence is not required during FEES
  • High-quality recorded imaging with same day copies provided
  • Allows for observation of secretions and/or aspiration of secretions, especially important for patients with tracheostomies
  • Allows for visualization of erythema and edema, relevant for reflux findings
  • No ingestion of barium
  • Allows for visualization of aspiration after the swallow, which is often missed on a MBSS because the radiologist turns off the fluoroscopy after the patient swallows to minimize exposure to radiation
  • No time limit for the FEES, allowing the SLP to trial multiple compensatory strategies

***More Literature Available Upon Request