Fibreoptic Endoscope Evaluation versus Video Fluoroscopic Swallowing Exams for Patients with Dysphagia: A Review of Diagnostic Accuracy and Cost-Effectiveness


Project Line:
Health Technology Review
Project Sub Line:
Summary with Critical Appraisal
Project Number:


  1. What is the diagnostic accuracy of fibreoptic endoscopic versus video fluoroscopic swallowing exams in patients with suspected dysphagia?
  2. What is the cost-effectiveness of fibreoptic endoscopic versus video fluoroscopic swallowing exams for patients with suspected dysphagia?

Key Message

This report identified evidence of limited quality from one systematic review that conducted a meta-analysis of six studies, and two prospective comparative studies that supported both fibreoptic endoscope evaluation of swallowing system (FEES) and video fluoroscopic swallowing exam/study (VFSS) as suitable diagnostic procedures for dysphagia. With regard to diagnostic accuracy of dysphagia parameters a lack of evidence for consistent diagnostic accuracy differences was identified. Limitations of the identified evidence included the absence of a suitable reference standard, a lack of safety data, and a lack of patient-related outcomes making the significance of diagnostic accuracy comparisons unclear. Given the lack of evidence for significant differences in diagnostic accuracy, other factors could be considered in the decision to implement FEES or VFSS. No cost-effectiveness evidence was identified comparing VFSS to FEES.