To compare the diagnostic yield of upper endoscopy between esophageal and oropharyngeal dysphagia, and to characterize the spectrum of structural, inflammatory, and motility-related findings in a real-world tertiary care setting.

We conducted a retrospective study of adults undergoing upper endoscopy for dysphagia between March and November 2025. Dysphagia was clinically categorized as esophageal or oropharyngeal. Endoscopic findings were classified as structural, inflammatory, motility-suggestive, or normal. Associations between dysphagia type and relevant endoscopic abnormalities were analyzed using chi-square tests and odds ratios (OR). High-resolution manometry was performed when motility disorders were suspected.

Among 196 patients, 123 (62.8%) had esophageal dysphagia and 73 (37.2%) or oropharyngeal dysphagia. The overall diagnostic yield was 64.3%. Frequent findings included hiatal hernia (24.5%), esophagitis (22.4%), peptic strictures (8.2%), malignancy (4.1%), Schatzki ring (2.0%), eosinophilic esophagitis (1.0%), and HRM-confirmed achalasia (2.0%); ineffective esophageal motility was identified in 3.6%.

Relevant abnormalities were significantly more common in esophageal than in oropharyngeal dysphagia (96.0% vs 11.0%, respectively), indicating a strong association (OR 32.1, 95% CI 12.8–80.5, p<0.001). In oropharyngeal dysphagia, endoscopy was predominantly normal.

Table 1. Endoscopic findings stratified by dysphagia type

Standard upper endoscopy provides high diagnostic yield in esophageal dysphagia, identifying a broad spectrum of clinically actionable abnormalities. In contrast, oropharyngeal dysphagia demonstrates low yield, supporting selective endoscopic referral. These real-world findings reinforce the utility of conventional endoscopy—without enhanced imaging—as an essential diagnostic tool in dysphagia evaluation in resource-limited settings.