Why is endoscopy often performed after a positive BSE in suspected dysphagia?

• A. To treat by dilation immediately
• B. To visualize mucosa for structural lesions and obtain biopsies if indicated
• C. To obtain biopsies only
• D. To visualize mucosa for mucosal motility

Answer: (B)

After a positive BSE, the main aim is to directly inspect the esophageal mucosa and obtain tissue for diagnosis. A barium swallow can reveal a narrowing or abnormal contour, but it cannot show the mucosal surface in detail or provide tissue samples. Endoscopy lets you see the lining of the esophagus closely, identify structural and mucosal abnormalities such as ulcers, rings, webs, strictures, or tumors, and take targeted biopsies from any suspicious areas. Those biopsies are essential to confirm conditions like inflammatory esophagitis, Barrett’s esophagus, eosinophilic esophagitis, infections, or cancer, and to guide appropriate treatment. Dilation might be performed if a stricture is found, but that’s not the primary reason for performing endoscopy after a positive BSE. Endoscopy also doesn’t assess esophageal motility—that’s evaluated with motility studies rather than endoscopy.