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Background <p>Flexible Endoscopic Evaluation of Swallowing (FEES) is a core diagnostic tool in neurogenic dysphagia. Despite a structured national training curriculum in Germany, little is known about current implementation practices and outpatient accessibility. This study mapped nationwide FEES practice patterns, workforce structures, and geographic access, and identified barriers to comprehensive service provision.</p> Methods <p>A nationwide web-based survey was conducted among certified FEES instructors in Germany. The survey assessed provider characteristics, implementation practices, diagnostic–therapeutic integration, and perceived systemic barriers. In parallel, institutional websites were screened for publicly advertised outpatient FEES services and geocoded for travel-time isochrone analyses.</p> Results <p>Eighty-two instructors completed the anonymous survey (response rate 52.6%). FEES was predominantly delivered in acute hospitals (74%) and rehabilitation clinics (46%) and embedded within interdisciplinary workflows. Outpatient availability remained limited (54%), with most institutions lacking statutory reimbursement pathways; additionally, many existing outpatient services were not visible to patients online. Geospatial analysis revealed substantial regional disparities, particularly in rural and eastern regions, with only a minority of residents able to reach a publicly identifiable outpatient FEES provider within 30&#xa0;min. Procedural experience varied widely, and higher monthly FEES volumes were associated with shorter examination duration (<i>r</i> = − 0.27, <i>p</i> = 0.020).</p> Conclusions <p>FEES is well implemented in German inpatient dysphagia care but structurally underdeveloped in the outpatient sector. Insufficient reimbursement, workforce shortages, and lack of transparency significantly impede equitable access. Strengthening outpatient infrastructure, establishing sustainable reimbursement mechanisms, and improving national visibility of services are critical steps toward ensuring continuity of dysphagia care.</p>

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Mapping neurogenic dysphagia diagnostics in Germany: accessibility, implementation practices, and barriers to swallowing endoscopy

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年3月18日

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  • Julia Gelenar Marae,
  • Lars Masanneck,
  • Marc Pawlitzki,
  • Cinja Huber,
  • Jule Hofacker,
  • Sriramya Lapa,
  • Anne Jung,
  • Paul Muhle,
  • Sonja Suntrup-Krueger,
  • Tobias Warnecke,
  • Sven G. Meuth,
  • Rainer Dziewas,
  • Bendix Labeit

摘要

Background

Flexible Endoscopic Evaluation of Swallowing (FEES) is a core diagnostic tool in neurogenic dysphagia. Despite a structured national training curriculum in Germany, little is known about current implementation practices and outpatient accessibility. This study mapped nationwide FEES practice patterns, workforce structures, and geographic access, and identified barriers to comprehensive service provision.

Methods

A nationwide web-based survey was conducted among certified FEES instructors in Germany. The survey assessed provider characteristics, implementation practices, diagnostic–therapeutic integration, and perceived systemic barriers. In parallel, institutional websites were screened for publicly advertised outpatient FEES services and geocoded for travel-time isochrone analyses.

Results

Eighty-two instructors completed the anonymous survey (response rate 52.6%). FEES was predominantly delivered in acute hospitals (74%) and rehabilitation clinics (46%) and embedded within interdisciplinary workflows. Outpatient availability remained limited (54%), with most institutions lacking statutory reimbursement pathways; additionally, many existing outpatient services were not visible to patients online. Geospatial analysis revealed substantial regional disparities, particularly in rural and eastern regions, with only a minority of residents able to reach a publicly identifiable outpatient FEES provider within 30 min. Procedural experience varied widely, and higher monthly FEES volumes were associated with shorter examination duration (r = − 0.27, p = 0.020).

Conclusions

FEES is well implemented in German inpatient dysphagia care but structurally underdeveloped in the outpatient sector. Insufficient reimbursement, workforce shortages, and lack of transparency significantly impede equitable access. Strengthening outpatient infrastructure, establishing sustainable reimbursement mechanisms, and improving national visibility of services are critical steps toward ensuring continuity of dysphagia care.