An Investigation of the Post-laryngectomy Swallow Using Videofluoroscopy and Fiberoptic Endoscopic Evaluation of Swallowing (FEES).

The analysed group was a small convenience sample, and some participants were excluded because the FEES recording failed. Many FEES neopharynx ratings were missing because the scope view did not allow raters to judge residue, so the neopharynx was excluded from some comparisons. The puree bolus stuck to the endoscope and made FEES unviewable in some cases, which may have affected neopharynx and prosthesis findings. The solid bolus was coated with barium rather than baked with it, which may have affected videofluoroscopy detection. There was no gold standard for residue, so the study cannot say whether FEES findings were true residue or clinically unimportant coating. Rater reliability was poor, especially for ratings of residue amount, so the scale used here should not be treated as dependable. Most ratings were positive, so simple agreement can look high even when the rating task is unreliable.

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Do not conclude that FEES is the better or more accurate tool because it found more residue. The study had no gold standard, agreement between the tools was no better than chance, and the authors say some FEES findings may be a thin coating of residue that is clinically unimportant.