Feasibility and Safety of Fiberoptic Endoscopic Evaluation of Swallowing in People with Disorder of Consciousness: A Systematic Review.

People with disorders of consciousness (DoC) often receive nutrition via a feeding tube and the swallowing ability in this population is not fully understood. In particular, fiberoptic endoscopic evaluation of swallowing (FEES) with people with DoC requires further investigation. The aim of this systematic review is to collate, assess and summarise the current evidence of whether FEES is feasible and safe with people with DoC. Multiple health databases were searched in November 2019 to identify studies which used FEES with people with DoC. Data extraction included demographic information, adverse events reported and outcomes related to oral feeding. The Diagnostic Accuracy Quality Scale (DAQS) was used to assess the quality of the studies. In total only four studies were found, all of which had a high risk of bias. Many participants went from nil by mouth to some degree of oral diet sometime after the FEES was completed with low reporting of adverse events associated with FEES. This suggests a potential for the use of FEES in people with DoC. However, the evidence is low and further studies are recommended to improve understanding of FEES with people with DoC. Recommendations for clinical practice and areas for future research are outlined.