Oesophageal strictures refer to any persistent intrinsic narrowing of the oesophagus.
The most common causes are fibrosis induced by inflammatory and neoplastic processes. Because radiographic findings are not reliable in differentiating benign from malignant strictures, all should be evaluated endoscopically.
Upper and middle oesophageal strictures most commonly result from
- Barrett oesophagus
- mediastinal radiation
- caustic ingestion
- congenital oesophageal stenosis
- oesophageal intramural pseudodiverticulosis
- skin diseases associated with mucosal ulceration, such as
- erythema multiforme
- epidermolysis bullosa dystrophica
Distal oesophageal strictures are caused by gastro-oesophageal reflux disease (GORD), either as a separate entity, or in the setting of:
- prolonged nasogastric intubation
- Zollinger-Ellison syndrome: high acidity reflux
- post partial or total gastrectomy: alkaline reflux
- performing the roux-en-Y procedure may avoid this, by diverting the pancreatic secretions and bile away from the gastric remnant
Benign strictures typically show smoothly tapering, concentric narrowing. Malignant strictures are characteristically abrupt, asymmetric, eccentric narrowings with irregular, nodular mucosa. Tapered margins may occur with malignant lesions because of the ease of submucosal spread of tumour.
- 1. Brant WE, Helms CA. Fundamentals of diagnostic radiology. Lippincott Williams & Wilkins. (2007) ISBN:0781765188. Read it at Google Books - Find it at Amazon
- 2 Karasick S, Lev-toaff AS. Esophageal strictures: findings on barium radiographs. AJR Am J Roentgenol. 1995;165 (3): 561-5. AJR Am J Roentgenol (abstract) - Pubmed citation
- 3. Luedtke P, Levine MS, Rubesin SE et-al. Radiologic diagnosis of benign esophageal strictures: a pattern approach. Radiographics. 23 (4): 897-909. doi:10.1148/rg.234025717 - Pubmed citation
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