Esophageal stricture
Updates to Article Attributes
Oesophageal stricture refers to any persistent intrinsic narrowing of the oesophagus.
Pathology
Aetiology
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
These most commonly result from:
- Barrett oesophagus
- mediastinal radiation
- caustic ingestion
- congenital oesophageal stenosis
- oesophageal intramural pseudodiverticulosis
- skin diseases associated with mucosal ulceration, such as
- pemphigoid
- erythema multiforme
- epidermolysis bullosa dystrophica
Distal oesophageal strictures
These are typically caused by gastro-oesophageal reflux disease (GORD), either as a separate entity or in the setting of:
- scleroderma
- prolonged nasogastric intubation
- Zollinger-Ellison syndrome: high acidity reflux
- post partial or total gastrectomy: alkaline reflux
- performing the
rouxRoux-en-Y procedure may avoid this, by diverting the pancreatic secretions and bile away from the gastric remnant
- performing the
Associations
Oesophageal strictures are often associated with a hiatal hernia.
Radiographic features
Benign strictures characteristically:
- smoothly tapering
- typically concentric narrowing, but may affect only one side of the oesophagus (asymmetric wall rigidity)
Malignant strictures are characteristically:
- abrupt
- asymmetric
- eccentric with irregular, nodular mucosa
Tapered margins may occur with malignant lesions because of the ease of submucosal spread of a tumour.
Treatment and prognosis
The risk of Barrett oesophagus in stricture is 20-40% and strictures should be evaluated endoscopically.
Benign oesophageal strictures are typically treated with dilation, providing symptomatic relief, however recurrent strictures do occur. Complex strictures (length >2 cm, tortuous) are more likely to be recurrent. Treatment of malignant strictures involves treating the underlying cause. In palliative strictures, stent placement and brachytherapy play a role 4.
-<li>post partial or total gastrectomy: alkaline reflux<ul><li>performing the <a href="/articles/roux-en-y-procedure">roux-en-Y procedure</a> may avoid this, by diverting the pancreatic secretions and bile away from the gastric remnant</li></ul>- +<li>post partial or total gastrectomy: alkaline reflux<ul><li>performing the <a href="/articles/roux-en-y-procedure">Roux-en-Y procedure</a> may avoid this, by diverting the pancreatic secretions and bile away from the gastric remnant</li></ul>
-</ul><p>Tapered margins may occur with malignant lesions because of the ease of submucosal spread of a tumour.</p><h4>Treatment and prognosis</h4><p>The risk of <a href="/articles/barrett-oesophagus">Barrett oesophagus</a> in stricture is 20-40% and strictures should be evaluated endoscopically. </p><p>Benign oesophageal strictures are typically treated with dilation, providing symptomatic relief, however recurrent strictures do occur. Complex strictures (length >2 cm, tortuous) are more likely to be recurrent. Treatment of malignant strictures involves treating the underlying cause. In palliative strictures, stent placement and brachytherapy play a role <sup>4</sup>. </p>- +</ul><p>Tapered margins may occur with malignant lesions because of the ease of submucosal spread of a tumour.</p><h4>Treatment and prognosis</h4><p>The risk of <a href="/articles/barrett-oesophagus">Barrett oesophagus</a> in stricture is 20-40% and strictures should be evaluated endoscopically. </p><p>Benign oesophageal strictures are typically treated with dilation, providing symptomatic relief, however recurrent strictures do occur. Complex strictures (length >2 cm, tortuous) are more likely to be recurrent. Treatment of malignant strictures involves treating the underlying cause. In palliative strictures, stent placement and brachytherapy play a role <sup>4</sup>.</p>
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