Absolute dysphagia

This man has absolute dysphagia and needs to be in hospital. He may have a malignancy, a peptic stricture or a food bolus. Neurological or muscle disorders are less likely. Most would arrange early cautious upper GI endoscopy or failing that a gastrograffin swallow (risk of aspirating barium). If a malignant lesion is likely then further investigations are needed to determine the best treatment strategy. Options include stenting, chemo-radiotherapy, PEG feeding (inserted either endoscopically or surgically) or palliation. Investigations such as CT, PET and endoscopic ultrasound allow staging of malignant disease and a multi-disciplinary approach to treatment is probably best.