Esophageal Stricture Workup

  • Author: Sandeep Mukherjee, MB, BCh, MPH, FRCPC; Chief Editor: Julian Katz, MD   more...
 
Updated: Jan 4, 2012
 

Laboratory Studies

  • Complete blood cell (CBC) count: Usually, the results of a CBC are within the reference range; however, anemia may develop due to chronic bleeding from severe esophagitis or carcinoma.
  • Liver profile: Usually, the findings are within the reference range; however, the liver profile may be abnormal if metastatic disease in underlying malignancy is present.
  • Complete metabolic panel: This study may allow assessment of the patient's nutritional status, especially in conjunction with weight loss.
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Imaging Studies

  • Barium esophagram
    • Barium esophagram provides an objective baseline record of the esophagus before medical therapy or endoscopic intervention.
    • This study also provides information about the location, length, and diameter of the stricture and the smoothness or irregularity of the esophageal wall (road map).
    • The information obtained can complement endoscopic findings.
    • Lesions, such as diverticula and paraesophageal hernias, that potentially may lead to increased risk of complications during endoscopy can be identified.
    • This study may be more sensitive than endoscopy for detection of subtle narrowings of the esophagus such as those caused by rings and peptic strictures that are greater than 10 mm in diameter.
    • This study has 100% sensitivity with luminal diameter less than 9 mm, and 90% sensitivity with luminal diameter greater than 10 mm.
  • Chest radiograph, posteroanterior (PA) and lateral: Chest radiography should be used as an adjunct if extrinsic compression is considered a possible etiology of esophageal stricture.
  • CT scanning
    • CT scans can be used to stage malignancies that produce esophageal strictures.
    • Accuracy in estimating the depth of tumor invasion is 60-69%.
    • Accuracy in determining spread to other organs is 82%.
  • Endoscopic ultrasound (EUS)
    • EUS is the most accurate means of identifying the extent of local invasion of an esophageal malignancy.
    • Accuracy in estimating the depth of tumor invasion in the esophagus is 92%.
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Other Tests

  • Twenty-four-hour esophageal pH monitoring: This study may be helpful in evaluating and documenting the adequacy of therapy in patients who remain symptomatic despite treatment with PPIs or fundoplication.
  • Esophageal manometry
    • This test is used to evaluate any patient suspected of having esophageal dysmotility.
    • It may be used as a preoperative tool before antireflux surgery to evaluate the presence of severe esophageal dysmotility.
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Procedures

  • Esophagogastroduodenoscopy (EGD)
    • This procedure can be used to establish or confirm the diagnosis of esophageal stricture, to seek evidence of esophagitis, to exclude malignancy, to obtain biopsy and brush cytology specimens, and to implement therapy.
    • EGD is more sensitive than barium esophagram in the identification of subtle mucosal lesions.
    • Subtle strictures may be missed when smaller and thinner endoscopes are employed, especially in the setting of minimal sedation.
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Histologic Findings

Initial histologic changes in the peptic stricture process include edema, cellular infiltration, basal cell hyperplasia, and vascular changes with a slight increase in type III collagen deposition on healing.

If untreated, the process can lead to progressive inflammation and ulceration involving the submucosa and muscularis mucosa. This can lead to damage of the muscular layer and the intrinsic nervous system of the esophagus, resulting in deposition of type I collagen with subsequent formation of scar tissue and stricture formation.

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Staging

CT scanning and EUS are used mainly to stage malignancies that produce esophageal strictures.

  • CT scanning - Sixty to 69% accurate in estimating the depth of tumor invasion and 82% accurate in determining spread to other organs
  • EUS - Most accurate means of identifying the extent of local invasion and 92% accurate in estimating the depth of tumor invasion in the esophagus
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Contributor Information and Disclosures
Author

Sandeep Mukherjee, MB, BCh, MPH, FRCPC  Associate Professor, Department of Internal Medicine, Section of Gastroenterology and Hepatology, University of Nebraska Medical Center; Consulting Staff, Section of Gastroenterology and Hepatology, Veteran Affairs Medical Center

Sandeep Mukherjee, MB, BCh, MPH, FRCPC is a member of the following medical societies: Royal College of Physicians and Surgeons of Canada

Disclosure: Merck Honoraria Speaking and teaching; Ikaria Pharmaceuticals Honoraria Board membership

Coauthor(s)

Rajeev Vasudeva, MD, FACG  Clinical Professor of Medicine, Consultants in Gastroenterology, University of South Carolina School of Medicine

Rajeev Vasudeva, MD, FACG is a member of the following medical societies: American College of Gastroenterology, American Gastroenterological Association, American Society for Gastrointestinal Endoscopy, Columbia Medical Society, South Carolina Gastroenterology Association, and South Carolina Medical Association

Disclosure: Pricara Honoraria Speaking and teaching; UCB Consulting fee Consulting

Specialty Editor Board

Maurice A Cerulli, MD, FACP, FACG, FASGE, AGAF  Associate Professor of Clinical Medicine, Albert Einstein College of Medicine of Yeshiva University; Associate Professor of Clinical Medicine, Hofstra Medical School

Maurice A Cerulli, MD, FACP, FACG, FASGE, AGAF is a member of the following medical societies: American Association for the Study of Liver Diseases, American College of Gastroenterology, American College of Physicians, American Gastroenterological Association, American Medical Association, American Society for Gastrointestinal Endoscopy, and New York Society for Gastrointestinal Endoscopy

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD  Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

Simmy Bank, MD  Chair, Professor, Department of Internal Medicine, Division of Gastroenterology, Long Island Jewish Hospital, Albert Einstein College of Medicine

Disclosure: Nothing to disclose.

Alex J Mechaber, MD, FACP  Senior Associate Dean for Undergraduate Medical Education, Associate Professor of Medicine, University of Miami Miller School of Medicine

Alex J Mechaber, MD, FACP is a member of the following medical societies: Alpha Omega Alpha, American College of Physicians-American Society of Internal Medicine, and Society of General Internal Medicine

Disclosure: Nothing to disclose.

Chief Editor

Julian Katz, MD  Clinical Professor of Medicine, Drexel University College of Medicine

Julian Katz, MD is a member of the following medical societies: American College of Gastroenterology, American College of Physicians, American Gastroenterological Association, American Geriatrics Society, American Medical Association, American Society for Gastrointestinal Endoscopy, American Society of Law, Medicine & Ethics, American Trauma Society, Association of American Medical Colleges, and Physicians for Social Responsibility

Disclosure: Nothing to disclose.

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Esophageal stricture. Endoscopic appearance of the distal esophagus showing a smooth stricture with a benign appearance.
 
 
 
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