Multilevel Dysphagia, when Deglutology meets Esophagology

17 Mar 2026 18:00 19:30

Vienna

Peter Pokieser Host

Three Case Examples

Presenters of the three cases: Peter Pokieser and Ludwig Kramer

Case 1: Diagnostic ambulant case

Patient: 63-year-old female
Height / Weight: 165 cm, 57 kg
General Condition: Good general condition, congenital extrapyramidal tremor, sometimes aspirating, no bronchopulmonary problems.
Clinical Presentation: Solid food dysphagia, especially with meat and bread, leading to regurgitation and constantly aggravating.
Videofluoroscopy: Oropharyngeal and esophageal videofluoroscopy reveals aspiration and esophageal stenosis, hiatal hernia and widening of the esophagogastric junction.

Time Schedule

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Case 2: Therapeutic hospitalized case

June 2, 2025 — Admission: Admission of a 76 year old female with long-standing reflux disease Los Angeles IV (stenosis), large hiatal hernia, ulcerous / necrotic lesions. Multiple co-morbidities, including oropharyngeal dysphagia with Parkinson disease and aspiration problems.
June 3, 2025 — Diagnosis: Diagnosis of distal esophageal perforation with esophago-bronchial fistula => intubation, ICU care required.
June 4, 2025 — Treatment: Implantation of Eso-SPONGE (Endo-VAC).
June 5, 2026 — Complication: Massive esophageal bleeding, critical hemodynamics => transfusion, ICU support.
June 6, 2025 — Complication: Right pleural effusion, chest tube inserted.
June 9, 2025 — Treatment: Laparoscopic insertion of jejunal catheter. Fully covered metal stent, acute renal failure.
June 12, 2026 — Complication: Jejunal catheter dislocation, laparotomy, abdominal VAC.
July 19, 2025 — Treatment: Esophageal stent removed.
July 21, 2025 — Complication: Retrosternal pain, dysphagia – aspiration pneumonia with respiratory failure.
July 23, 2025 — Treatment: Esophageal metal stent #2 (Hanaro).
Oct 9, 2025 — Treatment: Esophageal metal stent #3.
Jan 24, 2026 — Readmission: Stent migration, removal.
Feb 21, 2026 — Recurrence: Fistula recurrence, dysphagia, regurgitation.
Mar 5, 2026 — Treatment: Esophageal balloon dilation => 17 mm.

Case 3: Diagnostic ambulant case

Patient: 78-year-old male
Clinical Presentation: Suffering for more than 5 years from regurgitation of small pieces of food, repetitive swallows of saliva over the day and sometimes, estimated every two months, food gets stuck and drinking water takes a time of around 1 or 2 minutes before eating can be continued.
Oropharyngeal Videofluoroscopy: Reveals a small Zenker diverticulum and a considerable crico-pharyngeal bar and a Schatzki's ring, typically with a hiatal hernia.
Discussion Basis: Subtle analysis of the video-information represents the basis for panel discussion of diagnostic and therapeutic management.

Panel for Discussion

Prof. Dr. Rainer Dziewas, FESO
President of the European Society for Swallowing Disorders (ESSD)
Chairman, Department of Neurology and neurological rehabilitation
Klinikum Osnabrück – Academic teaching hospital of the University of Münster
Prof. Dr. Ludwig Kramer
Chairman, Klinik Hietzing, Department of Gastroenterology, Vienna
Ayodele Sasegbon
Gastroenterologist and clinical lecturer at the University of Manchester

Topics for Discussion

Ambulant and hospitalized patients can present with swallowing impairment synchronously at multiple levels of the upper GI-tract, namely the oropharyngeal, pharyngoesophageal, esophageal and esophagogastric level.
Interdisciplinary approach needs to consider all levels of possible coexisting pathologic conditions of morphologic and functional disease.
Thirty-seven Pilot Centers worldwide are currently listed in the network of the OESO-SEMPIRE Platform of Excellence in Esophagology to take part in the program of the OESO Virtual Educational Channel in Esophagology.
Such a program is in line with true multi-disciplinarity, the essence of OESO since its creation, and the mission defined by UNESCO in the Chair of Digital Education attributed in 2018, to the OESO Foundation at the University of Geneva.