Oesophageal webs refer to an oesophageal constriction caused by a thin mucosal membrane projecting into the lumen.
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Epidemiology
Oesophageal webs tend to affect middle-aged females.
Clinical presentation
Patients are usually asymptomatic and the finding may be incidental and unimportant. However, if the stenosis is severe symptoms include dysphagia and regurgitation of food.
Pathology
Location
More commonly occur in the cervical oesophagus near cricopharyngeus muscle than in the thoracic oesophagus. They typically arise from the anterior wall and never from the posterior wall; they can also be circumferential 4. Occasionally, multiple webs are visualised during maximal distension.
Associations
gastro-oesophageal reflux disease (especially a distal oesophagus web) 7
external beam radiation
Radiographic appearance
Fluoroscopy: barium swallow
may be demonstrated on high-volume barium oesophagrams when the oesophagus is fully distended 4
a "jet effect" of contrast passing distal to the web may be seen 6
Treatment and prognosis
An oesophageal web may indicate an oesophagus at higher risk of upper oesophageal and hypopharyngeal carcinoma.
Treatment options include:
balloon dilatation
bougienage (dilatation with a bougie) during endoscopy 8
Differential diagnosis
submucosal venous plexus: normal structure, noted anteriorly only as slightly irregular mucosa 5
Schatzki ring: occurs in the distal oesophagus
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