Esophageal Stricture Workup

Updated: Apr 27, 2016
  • Author: Kavitha Kumbum, MD; Chief Editor: BS Anand, MD  more...
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Workup

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 studies

Usually, the findings are within the reference range; however, the liver profile may be abnormal if metastatic disease is present in patients with an underlying malignancy.

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 esophagraphy

A 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 radiography

Posteroanterior (PA) and lateral films: Chest radiography should be used as an adjunct if extrinsic compression is considered a possible etiology of esophageal stricture.

Computed tomography (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; it is 92% accurate in estimating the depth of tumor invasion in the esophagus

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