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.

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.