EoE ToT Module 6 References-Dellon Cancer Therapy Advisor 2019 Esophageal strictures

Dellon Cancer Therapy Advisor 2019 Esophageal strictures - Cancer Therapy Advisor

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Esophageal strictures are narrowings of the esophagus that impede the passage of food and can have multiple causes, such as gastroesophageal reflux disease (GERD), radiation therapy, caustic injuries, eosinophilic esophagitis, or malignancies. The key symptom of esophageal strictures is dysphagia, specifically characterized by the sensation of food sticking in the esophagus. To differentiate esophageal dysphagia from oropharyngeal dysphagia, a thorough analysis of the patient's history and symptoms is required.<br /><br />Diagnosis mainly involves two modalities: upper endoscopy (esophagogastroduodenoscopy, EGD) and barium swallow. EGD is the preferred diagnostic method as it provides a direct view of the esophagus and allows for biopsies and therapy. Barium swallow is used in particular scenarios when suspecting very proximal esophageal lesions or complex strictures.<br /><br />Endoscopic characteristics help identify the type of stricture; for example, peptic strictures often occur at the gastroesophageal junction and may involve scarring, while radiation strictures are identified based on patient history. Malignancies are likely when dysphagia is accompanied by weight loss or anemia.<br /><br />Therapies for esophageal strictures include esophageal dilation, which can be mechanical (bougie dilation) or balloon dilation. For refractory cases, options like intralesional steroid injection and esophageal stenting are available. Esophageal dilation involves gradually increasing the esophageal diameter through successive sessions, though complex cases or complete obstructions may require specialized techniques such as combined antegrade-retrograde dilation.<br /><br />Side effects of dilation include esophageal perforation, chest pain, bleeding, and aspiration. Proper monitoring is essential, especially for complications like esophageal perforation, which requires immediate medical attention.<br /><br />Long-term management involves treating the underlying cause to prevent recurrence. For example, patients with peptic strictures often need ongoing GERD management. Serial dilations might be necessary for severe cases, and the frequency should be customized to each patient's needs.

Keywords

esophageal strictures

dysphagia

GERD

upper endoscopy

barium swallow

esophageal dilation

peptic strictures

malignancies

intralesional steroid injection

esophageal stenting