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Pract."],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats: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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A nationwide web-based survey was conducted among certified FEES instructors in Germany. The survey assessed provider characteristics, implementation practices, diagnostic\u2013therapeutic integration, and perceived systemic barriers. In parallel, institutional websites were screened for publicly advertised outpatient FEES services and geocoded for travel-time isochrone analyses.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      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\u00a0min. Procedural experience varied widely, and higher monthly FEES volumes were associated with shorter examination duration (\n                      <jats:italic>r<\/jats:italic>\n                      = \u2212\u20090.27,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.020).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats: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.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1186\/s42466-026-00473-9","type":"journal-article","created":{"date-parts":[[2026,3,18]],"date-time":"2026-03-18T15:33:31Z","timestamp":1773848011000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Mapping neurogenic dysphagia diagnostics in Germany: accessibility, implementation practices, and barriers to swallowing endoscopy"],"prefix":"10.1186","volume":"8","author":[{"given":"Julia Gelenar","family":"Marae","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lars","family":"Masanneck","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marc","family":"Pawlitzki","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cinja","family":"Huber","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jule","family":"Hofacker","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sriramya","family":"Lapa","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anne","family":"Jung","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paul","family":"Muhle","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sonja","family":"Suntrup-Krueger","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tobias","family":"Warnecke","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sven G.","family":"Meuth","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rainer","family":"Dziewas","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6094-3869","authenticated-orcid":false,"given":"Bendix","family":"Labeit","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,3,18]]},"reference":[{"issue":"6","key":"473_CR1","doi-asserted-by":"publisher","first-page":"876","DOI":"10.1212\/WNL.0000000000011350","volume":"96","author":"T Warnecke","year":"2021","unstructured":"Warnecke, T., Labeit, B., Schroeder, J., Reckels, A., Ahring, S., Lapa, S., et al. 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LM: has received honoraria for lecturing, consulting, and travel expenses for attending meetings from Biogen, Merck, Sanofi, ArgenX, Roche, Alexion, and Novartis, His research is funded by the German Multiple Sclerosis Foundation (DMSG) and the Deutsche Forschungsgemeinschaft (DFG, German Research Foundation)\u2014493659010. RD: is a former advisory board member of Phagenesis Ltd, and he serves as president for the European Society for Swallowing Disorders (ESSD) and chairman of the German Dysphagia Society (DGD) (unpaid). MP: received honoraria for lecturing and travel expenses for attending meetings from Alexion, ArgenX, Bayer Health Care, Biogen, Hexal, Merck Serono, Novartis, Roche, Sanofi-Aventis, Takeda and Teva. His research is funded by ArgenX, Biogen, Demecan, Hexal, Horizon Merck Serono, Novartis, Roche, Viatris, Takeda and Teva, all outside the scope of this work. His research is funded by the by the German Multiple Sclerosis Foundation (DMSG), the B.Braun Foundation and the German Alzheimer Society. JH: has received a scholarship from the German National Academic Foundation. SL: has received honoraria and travel grants for lectures and conferences from the German Society for Clinical Neurophysiology and Functional Imaging (DGKN), Phagenesis Ltd, the United European Gastroenterology (UEG), the German Stroke Society (DSG), argenx, AbbVie, and Merck, and serves as a consultant for Phagenesis Ltd. AJ: has received a travel grant for a conference from the German Society for Dysphagia (DGD) and honoraria for lectures from the German Society for Clinical Neurophysiology and Functional Imaging (DGKN) and Phagenesis Ltd. PM: has received honoraria for lectures from Nestle Health Science, Phagenesis Ltd and Alexion Pharma. SSK: is supported with an endowed professorship from the Else Kr\u00f6ner-Fresenius Foundation, has received honoraria from Phagenesis Ltd and served as congress president 2024 of the European Society of Swallowing Disorders (ESSD) (unpaid). TW: has received support for scientific projects from AbbVie, EVER Pharma, Clexio Bioscience Ltd, has received consulting fees from Desitin, BIAL, Stadapharm, Phagenesis, Merz, has received honoraria for lectures from BIAL, AbbVie, Desitin, Zambon. Pfizer, Britannia, Esteve and Merz. SGM: has received funding for research-projects from the German Ministry for Education and Research (BMBF), German Federal Institute for Risk Assessment (BfR), German Research Foundation (DFG), Else Kr\u00f6ner-Fresenius Foundation, Gemeinsamer Bundesausschuss (G-BA), German Academic Exchange Service, Hertie Foundation, Interdisciplinary Center for Clinical Studies (IZKF) Muenster, German Foundation Neurology, Ministry of Culture and Science of the State of North Rhine-Westphalia, the Daimler and Benz Foundation, Multiple Sclerosis Society North Rhine-Westphalia Regional Association (dmsg), Peek & Cloppenburg D\u00fcsseldorf Foundation, Hempel Foundation for Science, Art and Welfare, German Alzheimer Society e.V. Dementia self-help and Alexion, Almirall, Amicus Therapeutics Germany, Argenx, Bayer Vital GmbH, BGP Products Operations (Viatris Company), Biogen, BMS, Demecan, Diamed, DGM e.v., Fresenius Medical Care, Genzyme, Gesellschaft von Freunden und F\u00f6rderern der Heinrich-Heine-Universit\u00e4t D\u00fcsseldorf e.V., HERZ Burgdorf, Hexal, Janssen, Merck Serono, Novartis, Novo Nordisk Pharma, ONO Pharma, Roche and Teva, has received honoraria for lecturing, travel expenses and for attending meetings from Academy 2, Argenx, Alexion, Almirall, Amicus Therapeutics Germany, AstraZeneca, Bayer Health Care, Biogen, BioNtech, BMS, Celgene, Datamed, Demecan, Desitin, Diamed, Diaplan, DIU Dresden, DPmed, Gen Medicine and Healthcare products, Genzyme, Hexal AG, IGES, Impulze GmbH, Janssen Cilag, KW Medipoint, MedDay Pharmaceuticals, Medmile, Merck Serono, MICE, Mylan, Neuraxpharm, Neuropoint, Novartis, Novo Nordisk, ONO Pharma, Oxford PharmaGenesis, QuintilesIMS, Roche, Sanofi, Springer Medizin Verlag, STADA, Chugai Pharma, Teva, UCB, Viatris, Wings for Life international and Xcenda. BL: has received research funding from the German Research Foundation (DFG), Clexio Bioscience Ltd, the Medical Faculty of the University of M\u00fcnster, the Gesellschaft von Freunden und F\u00f6rderern der Heinrich-Heine-Universit\u00e4t D\u00fcsseldorf e.V (GFFU), has received scientific prizes from the German Geriatric Society (DGG) in conjunction with the Rolf and Hubertine Schiffbauer Foundation and the German Neurological Society (DGN), has received honoraria and\/or travel grants for lectures and conferences from the German Society for Clinical Neurophysiology and Functional Imaging (DGKN), the European Stroke Organization (ESO), the Society for Clinical Nutrition and Metabolism (ESPEN), Phagenesis Ltd, the German Society for Neurology (DGN), the European Society for Swallowing Disorders (ESSD), the United European Gastroenterology (UEG), the University of Strasbourg, the German Society for Muscular Dystrophy (DGM), the German Society for Nutritional Medicine (DGEM), the German Society for Internal Medicine (DGIM), the German Stroke Society (DSG), the University of Zurich, the Confederation of European Otorhinolaryngology - Head and Neck Surgery (CEORL-HNS), CONGRES ORPHEO, the Deutsche Interdisziplin\u00e4re Vereinigung f\u00fcr Intensiv- und Notfallmedizin (DIVI), Novartis, and Danone.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"17"}}