Modified Barium Swallow Study or FEES?

Both the Modified Barium Swallow Study and flexible endoscopic evaluation of swallowing (FEES) are the gold standard for assessing the efficiency and safety of the swallow.  There are benefits and drawbacks of each exam.  Sometimes, both exams can be necessary to provide a more complete assessment of the patient’s swallowing deficits.  Both of the studies are the gold standard for patients with difficulty swallowing.

Benefits of Modified Barium Swallow

A Modified Barium Swallow Study or Video Fluoroscopic Swallow Study assesses the oral, pharyngeal, and part of the esophageal phases of swallowing.  The patient is viewed laterally and/or anteriorly while under x-ray.  Different consistencies of barium are provided to the patient which are viewed under the fluoroscopy.  The procedure is performed by a radiologist in conjunction with a speech-language pathologist.  The radiation assesses anatomical deviations and also typically comments on airway invasion status.  The speech-language pathologist provides a report on the physiology of the swallowing.  Since the procedure requires radiation, it is limited in time.  

A Modified Barium Swallow may be best suited for individuals complaining of the following:

  • Complaints of foods stuck in the throat, particularly in the retrosternal area (although localization is not always accurate)
  • Complaints of oral stage problems
  • Can screen the esophagus
Limitations of the Modified Barium Swallow Study include: higher costs, radiation exposure which limits the time of the study, travel for the procedure, limited availability, may miss microaspiration, real food in not used (barium)

Benefits of Flexible Endoscopic Evaluation of Swallowing

There are advantages of Flexible Endoscopic Evaluation of Swallowing (FEES) over Modified Barium Swallow Studies.  Advantages include that FEES is mobile and can be provided at the patient’s bedside.  Therefore the patient does not have to travel which is necessary with MBS.  Since there is no travel for the patient, this keeps costs down for patient’s who are living in a facility or must pay for transportation.  It’s also been shown to be safer and more sensitive to aspiration and residue. 

FEES is most advantageous for the following:

  • Facility or home bound patients
  • Medically complex patients or patients who have difficulty transporting
  •  Patients who require longer studies 
  • May be more sensitive to microaspiration and residual
  • Can assess secretions
  • Less expensive
  • Real food
  • Direct visualization of the structures including vocal fold function
Disadvantages of the exam are that the esophagus cannot be screened, although some inferences can be made about the esophageal phase. There is also a white out period during the swallowing.  Aspiration can be viewed before and after the swallow and is inferred if it occurs during the swallow by checking the trachea after the swallow. 
NDoscopy Dysphagia Specialists perform FEES in New York and New Jersey.  Contact us to schedule at 646-389-4316

Improving quality of life for patients with dysphagia one scope at a time.


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