Original Title: Évaluation fluoroscopique ou endoscopique de la dysphagie chez la clientèle adulte

Authors' objectives: The Collège des médecins du Québec (CMQ) mandated the Institut national d'excellence en santé et en services sociaux (INESSS) to identify best practices and organizational arrangements to optimize the use of endoscopy and fluoroscopy (more specifically, modified barium swallow [MBS] and fiberoptic endoscopic evaluation of swallowing [FEES]) in the assessment of dysphagia in adults.

Authors' results and conclusions: RESULTS (#1 CLINICAL INDICATIONS GUIDING THE CHOICE OF INSTRUMENTAL TECHNIQUE): The choice of an assessment technique (MBS or FEES) should be primarily based on clinical indications (e.g. the necessity to evaluate a specific anatomical structure, function or phase of swallowing) developed through expert consensus. – MBS should be prioritized for assessing the oral phase of swallowing, the upper esophagus and the entire swallowing process. – FEES should be preferred for assessing secretions, laryngopharyngeal sensitivity, laryngeal residue, for direct visualization of swallowing process, or when repeated instrumental assessments are required. (#2 ORGANIZATIONAL ARRANGEMENTS FOR THE INSTRUMENTAL ASSESSMENT OF DYSPHAGIA-ORGANIZATIONAL ARRANGEMENTS FOR MBS (FLUOROSCOPY): An analysis of the clinical practice guidelines (CPGs) and regulatory documents identified, primarily intended for speech-language pathologists, reveals that the assessment of dysphagia through MBS : With respect to the professional and organizational framework surrounding MBS • requires an interdisciplinary approach; • is performed in a radiology department, with roles defined by national legislation and the regulatory framework governing each profession; • is primarly conducted in hospitals (although the context is rarely specified). (#2.1 ORGANIZATIONAL ARRANGEMENTS FOR FEES (ENDOSCOPY): An analysis of CPGs and guidance documents, primarily intended for speech-language pathologists according to the documents reviewed, indicates that FEES: With respect to the professional and organizational framework surrounding FEES • requires an interdisciplinary approach; • offers greater flexibility compared to MBS, since organizational arrangements do not require a technical platform; • can be performed in a variety of care settings (e.g., emergency, intensive care units, outpatient clinics, community settings) using transportable equipment; • is primarily recommended in hospitals for safety reasons; • ideally requires two professionals trained in both dysphagia and FEES. (#3 ECONOMIC AND ENVIRONMENTAL CONSIDERATIONS): Although some sources mention that FEES may be more cost-efficient than MBS, the lack of relevant economic information precludes a definitive conclusion. • No specific environmental data related to MBS and FEES were identified. However, it is worth noting that the fields to which MBS and FEES belong (radiology and endoscopy, respectively) have a significant carbon footprint. Thus, strategies for reducing the environmental footprint of MBS and FEES could be modeled on those found in radiology and endoscopy. CONCLUSION: In current practice, instrumental assessment using MBS or FEES are typically performed by physicians (particularly in Europe and Quebec), speech-language pathologists (notably in the United States and most Canadian provinces outside Quebec), or through interdisciplinary collaboration, depending on local protocols and regulatory authorizations. For both techniques, standardized protocols and procedures are essential for safe and effective instrumental evaluation.

Authors' methods: This state of knowledge is based on a rapid review of the literature (e.g., practice guides, clinical guidelines and other regulatory documents) conducted in accordance with INESSS’s rapid review guidelines. While both types of dysphagia (OD and ED) were included in the search strategy, very few documents on ED were identified. Due to the context of the mandate, the analysis primarily focuses on OD.

Project Status: Completed

URL for project: https://www.inesss.qc.ca/publications/repertoire-des-publications/publication/evaluation-fluoroscopique-ou-endoscopique-de-la-dysphagie-chez-la-clientele-adulte.html

Year Published: 2025

URL for published report: https://www.inesss.qc.ca/publications/repertoire-des-publications/publication/evaluation-fluoroscopique-ou-endoscopique-de-la-dysphagie-chez-la-clientele-adulte.html

English language abstract: An English language summary is available

Publication Type: Other

Country: Canada

Province: Quebec

Organisation Name: Institut national d'excellence en sante et en services sociaux

Contact Address: L'Institut national d'excellence en sante et en services sociaux (INESSS) , 2021, avenue Union, bureau 10.083, Montreal, Quebec, Canada, H3A 2S9;Tel: 1+514-873-2563, Fax: 1+514-873-1369

Contact Name: demande@inesss.qc.ca

Contact Email: demande@inesss.qc.ca

Copyright: L'Institut national d'excellence en sante et en services sociaux (INESSS)