Clinical Diagnosis of Esophageal Dysphagia Using Transnasal Esophagoscopy: A Case Report

The aim of the present study was three folds; (i) to correlate clinical case history with objective findings of a client presented with sternal discomfort along with odynophagia; (ii) to evaluate the cause for retrosternal discomfort using Functional Esophagoscopy (FE); and (iii) to reaffirm the Cook's (2008) algorithm for clinical diagnosis of esophageal dysphagia in single sitting using Transnasal Esophagoscopy (TNE). A 72 years old male (named 'G') visited a tertiary health care hospital with a complaint of imbalance for past 2 months. Also, had a complaint of pain while swallowing for the past 15 days along with left arm weakness (for past 2 days) and got admitted for treatment. Pertaining to swallowing, a detailed case history was taken and Fiber-optic endoscopic evaluation of swallowing (FEES) was performed to evaluate swallowing safety functions using digital swallowing workstation (KAYPENTAX, New Jersy, USA). A large growth was noticed in the lower border of esophagous using TNE in this patient. The oral, oro-pharyngeal, and pharyngeal phase of swallowing was intact. Esophageal phase of swallowing revealed reduced peristaltic movement including a mass lesion observed in client 'G' from TNE procedure. Clinical correlation of objective findings in this client corroborated well with history. Visualization studies including TNE can be used safely, comfortably in OPD basis without any anesthesia would be few advantages of TNE procedure. Even lesions at lower end of esophagus can be detected using TNE and it is concluded that the symptom retro-sternal discomfort might be clinically correlated with history and objectively determined by TNE procedure as esophageal dysphagia due to structural lesion. Also, algorithm of Cook's (2008) guides the investigation procedure quickly in a single sitting. Therefore, clinical history about patient is imperative that accurately guides further in terms of patient's care for assessment and treatment.