Background: The purpose of this study is to describe our experience in the observation of oropharyngeal dysphagia with endoscopic evaluations in patients suffering from ALS. Methods: We conducted a retrospective study of patients suffering from ALS managed with Serial Functional Endoscopic Evaluation of Swallowing. The patients were divided into no aspiration group and aspiration group based on the PAS scores obtained during the endoscopic evaluation of swallowing. Dysphagia was classified in according to ASHA -NOMS levels. Results: A total of 32 patients was examined and a different progression pattern of dysphagia was observed. Conclusion: Non-linear evolution of dysphagia with a plateau in patients affected by bulbar onset type ALS was observed.