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Open Access Research article

Towards a basic endoscopic evaluation of swallowing in acute stroke – identification of salient findings by the inexperienced examiner

Tobias Warnecke*, Inga Teismann, Stephan Oelenberg, Christina Hamacher, E Bernd Ringelstein, Wolf R Schäbitz and Rainer Dziewas

Author Affiliations

Department of Neurology, University Hospital of Münster, Albert-Schweitzer-Str. 33, D-48129 Münster, Germany

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BMC Medical Education 2009, 9:13  doi:10.1186/1472-6920-9-13

Published: 10 March 2009



Dysphagia is common after stroke. Fiberoptic endoscopic evaluation of swallowing (FEES) is a powerful tool for dysphagia assessment. The purpose of this study was to assess whether a previously established endoscopic examination protocol based on the identification of typical findings indicative of stroke – related dysphagia may be learned and adopted by clinicians so far inexperienced in this field.


After receiving a structured lecture on this topic, participants were asked to rate video sequences of endoscopic swallowing examinations of acute stroke patients. The first part of the testing ("single findings-rating") comprised of 16 single sequences, the second part ("complete examination-rating") presented the key sequences of 8 complete examinations. Before the second part was started, results of the first were discussed.


At the "single findings-rating" 88.8% of video-sequences were assessed correctly, while at the "complete examination-rating" the average performance had improved to 96%. Furthermore, no overlooking of relevant pathologies was noted in the second part of the testing.


This study suggests that the presented endoscopic examination protocol is reliably interpreted by inexperienced clinicians after a short lecture and may therefore easily and successfully be adopted in dysphagia management of acute stroke care.