A Scoping Review and Tutorial for Developing Standardized and Transparent Protocols for Flexible Endoscopic Evaluation of Swallowing

Abstract

Purpose: Standardization and transparency are essential components for enhancing an assessment's objectivity and reproducibility. Currently, it is up to the individual clinician to develop a standardized protocol that works for their clinical setting and patient populations. Therefore, the primary aim of this clinical focus article is to present a scoping review of research that can aid clinicians as they develop standardized and transparent protocols for flexible endoscopic evaluation of swallowing (FEES). Method: A brief background is provided characterizing the diagnostic advantages and limitations of FEES and describing why increased standardization and transparency for the performance of FEES is needed. Research examining examination preparation parameters (topical nasal anesthetics, vasoconstrictors, lubrication, anxiety) and swallowing protocols (swallowing instructions, bolus volumes, bolus consistencies, number of trials, colorants) is then explored. Last, step-by-step instructions and examples on developing a protocol are outlined. Conclusions: FEES is a gold standard approach for examining functional swallowing outcomes in people with known or suspected dysphagia. Standardizing and transparentizing the performance of FEES, the swallowing protocol, and the rating methods are critical for successful use of FEES in clinical and research practices.