# Safety of FEES Performed by Speech-Language Pathologists and Physicians–Evidence Supporting Task Sharing from a Retrospective Observational Study of 964 Consecutive Examinations

## TL;DR

This study shows that a swallowing test called FEES is safe when performed by speech therapists or doctors, even in patients with certain conditions.

## Contribution

The study provides evidence supporting task sharing for FEES in healthcare systems where the procedure is not yet routine.

## Key findings

- The overall complication rate for FEES was 1.14%, with no significant difference between operators or settings.
- Complications were self-limiting, and patients with amyotrophic lateral sclerosis appeared to be at higher risk.
- Task sharing between speech-language pathologists and physicians increases service capacity and reduces delays.

## Abstract

(1) Background: Fiberoptic Endoscopic Evaluation of Swallowing (FEES) is one of the two gold-standard tools for assessing oropharyngeal dysphagia (alongside Videofluoroscopic Swallowing Study). Although generally considered safe, concerns about complications persist, particularly in systems where FEES is not routine and professional roles differ. The aim of this study was to evaluate the safety of FEES performed by both speech-language pathologists (SLPs) and physicians, in order to provide evidence of its safety in a healthcare system where the procedure is not yet widely established and to identify patient subgroups potentially at higher risk of procedure-related complications. (2) Methods: This retrospective study analyzed 964 consecutive FEES procedures. Examinations were carried out by trained SLPs or physicians. Data included demographics, clinical status, operator qualifications, setting, and complications, classified as minor (vomiting, poor tolerance, early termination) or major (laryngospasm, epistaxis). (3) Results: The overall complication rate was 1.14% (11/964): 0.6% minor and 0.5% major. All events were self-limiting. Complication rates did not differ between SLPs (1.05%) and physicians (1.23%) or by experience, setting, drug use, penetration–aspiration scale score, or nasogastric tube. Four complications occurred in amyotrophic lateral sclerosis patients, suggesting higher risk. (4) Conclusions: FEES is safe and well tolerated when performed by either physicians or SLPs. These findings underscore the value of task sharing in dysphagia diagnostics, demonstrating that a shared model increases service capacity, reduces delays, and facilitates timely management of dysphagia.