**1. Introduction**

The management of patients with swallowing disorders must involve a team of specialists whose work is aimed at preventing complications, ensuring a proper hydration and nutrition; as well as the the best quality of life to the patient [1]. This is an axiom that has guided our clinical activity for over 25 years. The goals of the team [2], in fact, can be summarized as follows:


The first three goals require an instrumental assessment. In other words the definition of the bio-mechanical events that are responsible of the deglutition disorder, have to be assessed with one or more instrumental tools, able to define the altered or mistimed movements, or muscular patterns, that compromise the passage of the bolus through the oral and pharyngeal cavities [3].

Simplifying such an approach, the evaluation of the clinical severity of a swallowing disorder remains a crucial aspect to determine, when managing patients with diseases or co-morbidities that may predispose them to respiratory or nutritional complications. The evaluation of the risk of complications, as just mentioned earlier, is a value that synthesizes data regarding the

patient in his/her totality, in relation to physical parameters (age, sex, race), the main pathology or other co-morbidities, the possibilities of an ecological management of the deglutition disorders (ie the possibility to effect behavioral strategies), also considering the wish of the patient and of the family [1].

The systematic method of the FEES (fiberoptic endoscopic evaluation of swallowing) evalua‐ tion is reported elsewhere in this book.

In this chapter the utility of endoscopy in the evaluation of dysphagic patients, new ways to conceive endoscopy and the correlations of endoscopy with a whole clinical context in the attempt to determine severity, will be discussed.
