Polish Standards for Performing Diagnostic Procedures in Oropharyngeal Dysphagia: Flexible Endoscopic Evaluation of Swallowing (FEES) and Videofluoroscopic Swallow Study (VFSS)

Introduction: Swallowing disorders constitute a diagnostic and therapeutic challenge across numerous medical specialties, affecting, among others, patients’ quality of life, exacerbations of chronic diseases, development of lower respiratory tract infections, malnutrition and sarcopenia. In the case of oropharyngeal dysphagia, instrumental assessments, like flexible endoscopic evaluation of swallowing (FEES) and videofluoroscopic swallowing study (VFSS), are considered the gold standard. The development of standardized protocols tailored to the clinical and legal frameworks of a given country is essential for ensuring safe and effective patient care.Material and Methods: This paper is based on an analysis of European and American clinical guidelines and recommendations, national legal regulations, and medical specialization curricula in Poland. A comprehensive review of Polish- and English-language literature was performed, including validated scales and questionnaires adapted into Polish, as well as postgraduate educational opportunities available within the European Union.FEES and VFSS Standards: The presented standards for FEES and VFSS encompass the following elements: type of examination, organizational framework including interdisciplinary team roles, indications, contraindications and associated risks, technical equipment and additional accessories required for the procedures, as well as the information necessary for preparing a comprehensive report and communicating results to the patient.Some components of these standards are universal (independent of the country in which the procedure is performed), while others reflect the specific organization of professional training, healthcare systems, and legal regulations in Poland. It should be emphasized that the aim of these procedures is not merely to confirm the presence of swallowing disorders, but to understand the underlying pathophysiological mechanisms of dysphagia in a given clinical case. This allows for establishing a diagnosis within a general medical context and implementing the most effective therapeutic strategy (rehabilitation, conservative treatment and/or surgical intervention).Conclusions: Instrumental swallowing assessments involve significant responsibility and require specialized expertise, technical preparation, access to high-quality equipment and the establishment of interdisciplinary teams. Incorrect therapeutic decisions may pose a direct threat to patient health and life. The primary goal of standardization is to improve the organization of procedures; however, individualized clinical decision-making remains essential in every case. Currently FEES and VFSS are not recognized as independent procedures in the International Classification of Medical Procedures (ICD-9).Keywordsoropharyngeal dysphagia, FEES, VFSS, IDDSI, aspiration, penetration, malnutrition, sarcopenia