Odynophagia After Upper Endoscopy: An Unusual Finding

Abstract

Question: A 56-year-old woman with a history of solid food dysphagia had an outpatient upper endoscopy. Six years ago a lower esophageal (Schatzki’s) ring was found and dilated with a 60-F Maloney bougie. Two years ago, symptoms recurred and the ring was partially obliterated with 4 biopsies using jumbo forceps. She felt well for 2 years, but symptoms again recurred and she underwent a third upper endoscopy for complete ring obliteration with 10 biopsies. This procedure (under propofol sedation) lasted 35 minutes and required repeated suctioning of oropharyngeal secretions. She felt well thereafter and went home. Two days later, the patient awoke with a very painful sore throat, pronounced difficulty in swallowing, and a foreign body sensation in her throat. A photograph of her oropharynx is shown in Figure A. The head and neck examination was otherwise normal, and there was no fever. Three days later all symptoms persisted and a second photograph was taken (Figure B). What is the diagnosis and how should it be managed? Look on page 913 for the answer and see the GASTROENTEROLOGY web site (www.gastrojournal.org) for more information on submitting your favorite image to Clinical Challenges and Images in GI.