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Esophageal strictures (esophagus) is a tube-shaped organ of 20-25 cm in length, 2.5-3 cm in diameter, located between the pharynx and stomach in the digestive system, and its main task is to transmit the chewed food in the mouth to the stomach.
A stricture (stricture) in any part of the esophagus causes difficulty in descending into the stomach by staying in the esophagus (difficulty swallowing, dysphagia).
Difficulty in swallowing is not evident unless the esophagus diameter is less than 2 cm and may be difficult to notice by the patient.
While it is difficult to swallow solid foods in mild constrictions, as the severity of the narrowing increases, it becomes difficult to swallow liquid foods.
In the formation of severe stenosis, the patient is no longer able to eat or drink anything, and swallowed foods and saliva begin to come back into the mouth (regurgitation). There may be pain and/or a feeling of fullness behind the breastbone along with difficulty in swallowing. Patients often lose weight.
In stenosis of the esophagus due to organic diseases (cancer, caustic stenosis, stenosis after radiotherapy, etc.), swallowing difficulty is progressive and there is weight loss in a short time, while in functional strictures (achalasia, corkscrew esophagus, muscle diseases, etc.) it occurs intermittently and over the years. There is a slow progressing difficulty in swallowing and weight loss.
Many diseases can cause narrowing of the esophagus. The most common strictures are benign (due to benign diseases) strictures. The most common of these is the strictures called peptic stricture, which can occur as a result of poorly treated chronic gastroesophageal reflux disease.
The scar tissue formed in this region after chronic inflammation (inflammation) and healing attacks caused by chronic acid reflux at the lower end of the esophagus causes a narrowing over time.
It is often found with a gastric hernia (hiatal hernia). The reason for this is that reflux disease progresses more severely in the presence of gastric hernia.
Although peptic strictures can occur at any age, they are more common after the age of 40.
Another condition that can cause narrowing without peptic structure in these patients is the Shatski ring, which is a ring-shaped structure that occurs at the junction of the esophagus and stomach. Shatski ring, which causes swallowing difficulties, can be easily treated with endoscopic methods.
Another cause of benign narrowing in the esophagus is the narrowing that occurs after accidentally ingesting strong acid or alkaline liquid cleaning agents (caustic substances) or pesticides.
Another cause that can be counted among the benign causes of stenosis is radiotherapy.
Persistent narrowing of the esophagus may occur after radiotherapy in the treatment of lung, breast and laryngeal cancers and lymphoma. Treatment of esophageal strictures is very difficult in clinical practice.
Other causes of benign narrowing of the esophagus include eosinophilic esophagitis, external vascular compression to the esophagus (Dysphagia Lusoria, aortic aneurysms, etc.), large esophageal diverticula (Zenker’s diverticulum), anastomotic strictures, achalasia, and benign tumors of the esophagus.
Congenital (since birth) strictures in the esophagus can also cause difficulty in swallowing. These strictures are structures consisting of membranous or band-shaped rings and are usually located in the upper and middle parts of the esophagus and can be easily treated.
Cancer of the esophagus can occur anywhere in the esophagus. Cancers in the upper and middle esophagus are mostly squamous cell cancers, while cancers in the lower esophagus are usually adenocancer type (See. Esophageal cancer).
While surgical treatment is applied to esophageal strictures in patients caught in the early period, radiotherapy, chemotherapy and endoscopic treatments are preferred in advanced cases.
In tumors of the upper part of the esophagus after the pharynx (cervical esophagus), surgical and endoscopic treatments are generally not satisfactory, so radiotherapy is preferred in the treatment.
Esophageal (esophageal) dilatation is the widening of the narrowed part of the esophagus for any reason by using different methods.
Various techniques can be used for this process. Today, the most preferred method is endoscopic balloon dilatation.
In benign strictures of the esophagus, dilatation (widening) of the narrow region with bougie and/or balloon is the first treatment method of choice. For this purpose, different sizes of spark plugs and balloons are used.
Dilation procedures are endoscopic methods applied by gastroenterologists and are usually performed under x-ray and sedation.
In some cases, one dilatation is sufficient and provides a long-term improvement, while in some cases, it is necessary to repeat the dilatations.
Complications such as bleeding, rupture (perforation) in esophageal strictures, and infection may occur after dilation, although rare.
Electrocautery or cutting with APC (Argon plasma coagulation) is another method that can be used in stenosis of anastomosis and stenosis formed by esophageal rings.
