Dysphagia endoscopy

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Hamid Qazi, MD, BSc [2], Feham Tariq, MD [3]

Overview

FEES and VFSS may be helpful in the diagnosis of dysphagia. The FEES uses a transnasal laryngoscope, and swallowing is directly evaluated by using measured quantities of food colored with blue liquid dye and compared before and after swallowing.

Endoscopy

Flexible fiberoptic endoscopic examination of swallowing (FEES)

Indications

FEES is indicated in

• In critically ill patients.
• Patients who cannot be transferred to the fluoroscopy room.
• Patients who require prompt evaluation.

Procedure

• A scope is passed through the nasal cavity to evaluate nasopharynx, laryngopharynx, and hypopharynx.
• If no structural abnormalities are seen, pharyngeal response is tested before and after swallowing.
• A normal endoscopy is followed by manometry.

Interpretation of FEES

The endoscopy findings for dysphagia are as follows:

• Middle and lower biopsies of the esophagus should be taken with the intention of excluding eosinophilic esophagitis.
• Majority will be normal or demonstrates only mild erosive disease.
• Structural abnormalities
  • Strictures
  • GERD
  • Webs/Rings

Endoscopic image of peptic stricture, or narrowing of the esophagus near the junction with the stomach. This is a complication of chronic gastroesophageal reflux disease, and can be a cause of dysphagia.