Patient description: A 52-year-old African American man with a history of heavy smoking and drinking, describes progressive dysphagia that began several months ago. He first noticed difficulty swallowing meat. His trouble swallowing then progressed to include other solid foods, soft foods, and then liquids. He is able to locate the point where food is obstructed at the lower end of his sternum. He has lost a total of 25 pounds.

Clinical trial eligibility criteria: eligible ages (years): 18.0-999.0,  Oropharyngeal Dysphagia (OPD) Dysphagia Profound oropharyngeal feeding tube dependent dysphagia of greater than 12 months duration, as documented by the prevalence of aspiration on fluoroscopic swallow study Must be receiving 100% of nutritional requirements by enterogastric tube years of age and older, acceptable forms of documentation for verification of age birth certificate, passport, and/or driver's license Diminished upper esophageal sphincter opening defined as less than .55 cm for individuals under 65 years of age and less than .40 cm for individuals over 65 years of age on fluoroscopic swallow study Failure of > 3 months of dysphagia therapy within 3 months of study enrollment No documented history of noncompliance with feeding recommendations Cognition that is within normal limits, as evidenced by an Abbreviated Mental Test Score (AMTS) score greater than 6 Manual dexterity that is within normal limits for age, sex, and hand, as evaluated by a Block and Box Test (BBT) Physical strength to pull the SED forward, as evidenced by the ability to lift a 5 lb weight off of a table and keep it elevated for 10 seconds Ability to understand the informed consent and comply with follow-up, as evidenced by appropriate questions, responses, and comments during the initial evaluations and a normal Abbreviated Mental Test Score  Profound oropharyngeal feeding tube dependent dysphagia < 12 months duration Esophageal phase dysphagia as defined as personal history and/or documented diagnosis of esophageal dysmotility, hiatal hernia, stricture, eosinophilic esophagitis, erosive peptic esophagitis, and/or systemic disease affecting the esophagus Able to safely consume any food or liquid by mouth, as documented by fluoroscopic swallow study Normal UES opening, as evidenced by UES opening greater than .55 cm for individuals under 65 years of age and greater than .40 cm for individuals over 65 years of age on fluoroscopic swallow study Currently pregnant, as evidenced by a positive result on a pregnancy test if the patient is within child bearing age (younger than 60 years of age) years of age and younger, acceptable forms of documentation for verification of age birth certificate, passport, and/or license Success full receipt of dysphagia therapy or < 3 months of dysphagia therapy within 3 months of study enrollment Lack of manual dexterity to operate swallowing expansion device as determined by a Block and Box Test (BBT) score below the normal limits per age, sex, and hand Inability to lift a 5 lb weight off of a table and keep it elevated for 10 seconds Lack of cognitive ability to operate swallowing expansion device or provide informed consent as evidenced by an Abbreviated Mental Test Score (AMTS) score less than 6