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<p>Neurogenic dysphagia is a clinically significant complication of adult neurological disorders, associated with aspiration, pneumonia, poor functional outcomes. Fiberoptic Endoscopic Evaluation of Swallowing (FEES) is widely used for instrumental assessment owing to its practicality. However, heterogeneity exists in how FEES is performed, how outcomes are measured, limiting comparability and clinical translation. To systematically review the literature on the use of FEES in adults with neurological disorders, focusing on assessment protocols, procedural components, bolus administration, and reported swallowing-related outcome measures. This systematic review followed PRISMA2020 guidelines. PubMed/MEDLINE, Scopus, Web of Science, and Cochrane Library were searched for studies published until January 2026. Eligible studies included adults (≥ 18 years) with neurological disorders undergoing FEES and reporting at least one FEES-derived swallowing outcome. Data extraction, risk of bias assessment (RoB 2, Newcastle–Ottawa Scale) were performed independently by two reviewers. Owing to the clinical and methodological heterogeneity, the findings were synthesised narratively. Twenty-four studies (&gt; 3,500 FEES examinations) across diverse neurological conditions (including stroke, Parkinson’s disease, amyotrophic lateral sclerosis, other neurodegenerative disorders) were included. All studies used transnasal flexible endoscopy, but protocols varied in structure, bolus consistencies and volumes, sensory testing, and assessment sequences. Penetration–aspiration (mostly using PAS), pharyngeal residue (often using the Yale scale), secretion severity, and composite FEES-based severity scores (e.g., FEDSS, DIGEST-FEES) were the frequently reported outcomes. Liquids consistently posed the highest aspiration risk, with frequent silent aspiration. Pharyngeal residue was the most prevalent abnormality and was correlated with functional intake and disease severity. FEES findings were strongly associated with pneumonia, diet modification, functional outcomes, and healthcare utilisation. FEES is a safe, clinically valuable tool for evaluating dysphagia, but heterogeneity in protocols, outcome reporting limits cross-study comparability. Standardised FEES protocols and multidimensional outcome reporting are needed to improve clinical interpretation and research translation.</p>

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Fiberoptic Endoscopic Evaluation of Swallowing in Adult Neurological Disorders: A Systematic Review of Assessment Methods and Outcome Reporting

  • 期刊论文

  • 发表日期：

    2026年6月19日

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  • A. Sharika Sakunthala,
  • C. R.K. Balaji,
  • A. Grahalakshmi,
  • D. Pradeep

摘要

Neurogenic dysphagia is a clinically significant complication of adult neurological disorders, associated with aspiration, pneumonia, poor functional outcomes. Fiberoptic Endoscopic Evaluation of Swallowing (FEES) is widely used for instrumental assessment owing to its practicality. However, heterogeneity exists in how FEES is performed, how outcomes are measured, limiting comparability and clinical translation. To systematically review the literature on the use of FEES in adults with neurological disorders, focusing on assessment protocols, procedural components, bolus administration, and reported swallowing-related outcome measures. This systematic review followed PRISMA2020 guidelines. PubMed/MEDLINE, Scopus, Web of Science, and Cochrane Library were searched for studies published until January 2026. Eligible studies included adults (≥ 18 years) with neurological disorders undergoing FEES and reporting at least one FEES-derived swallowing outcome. Data extraction, risk of bias assessment (RoB 2, Newcastle–Ottawa Scale) were performed independently by two reviewers. Owing to the clinical and methodological heterogeneity, the findings were synthesised narratively. Twenty-four studies (> 3,500 FEES examinations) across diverse neurological conditions (including stroke, Parkinson’s disease, amyotrophic lateral sclerosis, other neurodegenerative disorders) were included. All studies used transnasal flexible endoscopy, but protocols varied in structure, bolus consistencies and volumes, sensory testing, and assessment sequences. Penetration–aspiration (mostly using PAS), pharyngeal residue (often using the Yale scale), secretion severity, and composite FEES-based severity scores (e.g., FEDSS, DIGEST-FEES) were the frequently reported outcomes. Liquids consistently posed the highest aspiration risk, with frequent silent aspiration. Pharyngeal residue was the most prevalent abnormality and was correlated with functional intake and disease severity. FEES findings were strongly associated with pneumonia, diet modification, functional outcomes, and healthcare utilisation. FEES is a safe, clinically valuable tool for evaluating dysphagia, but heterogeneity in protocols, outcome reporting limits cross-study comparability. Standardised FEES protocols and multidimensional outcome reporting are needed to improve clinical interpretation and research translation.