A Case Series of Unsedated, Empiric UES Dilation for Oropharyngeal Dysphagia

Distal esophageal obstruction can present as proximal dysphagia. However, 22% of the elderly population experience oropharyngeal dysphagia which may be mistaken by gastroenterologists as resulting from a distal esophageal lesion. We present a case series of patients who were studied in the motility lab for possible causes of esophageal dysphagia but on careful history were noted to have oropharyngeal dysphagia. Immediate treatment included unsedated, Maloney dilation of the UES. All patients were all female (31 to 61, mean 51). The diagnosis of oropharyngeal dysphagia (OPD) was historically determined by noting difficulty of food or liquids traversing the oropharynx. Many had symptoms of globus, proximal dysphagia, gagging and coughing with swallowing. Most had unremarkable EGD and HRM studies. Maloney dilations were performed in the motility laboratory following topical anesthesia (lidocaine) to the oropharynx. Dysphagia score (DS), Food scores (FS) and Functional Outcome Swallowing Scale (FOSS) were measured before and immediately after the intervention. All patients tolerated Maloney dilations well (44F-52F). The number of dilations ranged from 1-2. Immediate improvement in dysphagia was noted in all patients as evidence by the ability to easily drink water. Subsequent follow-up (30 days) indicated continued improvement in dysphagia. DS, (mean pre 4 vs. 1.5 post, 62% improvement, p=0.10), FS (mean pre 9.7 vs. 1.5 post, 84% improvement, p=0.18) and FOSS (mean pre 3 vs. 0.5 post, 83% improvement, p=0.86) scores showed marked improvement that did not reach statistical significance because of our limited number of subjects. (1) Careful histories can distinguish between esophageal and oropharyngeal dysphagia. (2) Unsedated Maloney dilations of the posterior pharynx and cricopharyngeus muscle are very effective in treating OPD. (3) OPD is more prevalent than realized and is a very treatable disorder. (4) Further studies are needed to further clarify the role for empiric, unsedated dilation in OPD.Table: Table. Dysphagia before and after dilation