Will levels of experience of examiners affect the diet provided for patients with swallowing impairment?

OBJECTIVE: Flexible endoscopic evaluation of swallowing (FEES) is widely performed to determine the safety of oral intake. However, evaluation results can vary among examiners depending on their experience. To analyze the impact of such differences, we investigated the diet provided for patients with swallowing impairment evaluated by experienced and inexperienced examiners.

METHODS: We included 20 subjects with swallowing impairment. They underwent FEES twice, once by an experienced examiner (EE) and once by an inexperienced examiner (IE), in random order. The second FEES was generally performed within one month of the first FEES. The diet provided by the EE (EE results) and by the IE (IE results) during and after FEES was investigated and statistically compared. Respiratory and oral intake conditions at each time of FEES were also investigated and the results were included in the corresponding EE or IE results.

RESULTS: The median interval between FEES was 13.5 days. There was no significant difference between the EE and IE results regarding swallowing impairment-related conditions, such as amount of sputum suctioned, oral intake status, or prevalence of fever after FEES. However, there was a significant difference in the texture-modified diet provided after FEES: A close-to-normal diet was provided by the EE compared to the diet provided by the IE.

CONCLUSION: This study demonstrated a difference in the provided diet for patients with swallowing impairment between the examiners with different levels of experience. Our results suggest that EEs may be able to safely recommend patients with swallowing impairment have a close-to-normal diet.