How do I determine the appropriate timing for endoscopy in patients with dysphagia or odynophagia?

Determining the appropriate timing for endoscopy in patients presenting with dysphagia or odynophagia involves assessing the severity, duration, and associated risk factors of symptoms. Urgent endoscopy is indicated if there are alarm features such as progressive dysphagia, weight loss, persistent odynophagia, or suspicion of malignancy, as per NICE guidelines on suspected cancer referral NICE NG12.

For patients with new-onset dysphagia without alarm symptoms, endoscopy should be performed promptly to exclude structural causes, especially if symptoms persist beyond a few weeks despite initial management NICE CG184,NICE NG12.

In cases where odynophagia is present, endoscopy is warranted early to identify mucosal lesions, infections, or inflammatory conditions, particularly if symptoms are severe or accompanied by systemic signs NICE CG184.

Surface electromyography, as described by Vaiman & Eviatar 2009, may serve as a non-invasive screening tool to evaluate swallowing function and help triage patients for endoscopy, potentially optimizing timing by identifying those who require urgent investigation versus those suitable for conservative management Vaiman & Eviatar 2009.

Overall, the timing of endoscopy should be individualized based on clinical assessment, with immediate referral for endoscopy in high-risk patients and considered early in persistent or unexplained cases of dysphagia or odynophagia NICE CG184,NICE NG12 Vaiman & Eviatar 2009.