Esophageal Strictures: Benign & Peptic Strictures

00:01 Benign Stricture is our topic.

00:04 Benign Stricture : Peptic, caustic or anastomotic mucosal injury.

00:11 So there’s a number of things that are causing injury to the esophagus.

00:15 Whenever there’s injury begin the repair process.

00:17 So therefore, there might be fibrosis.

00:20 But the way that the fibrosis is taking place here would not be scleroderma type where you would find maybe random diffuse collagen deposition throughout the esophagus, but more or less stricture formations.

00:32 And that stricture formation making it more difficult for food particles to then move forward.

00:38 Peptic strictures are smooth and short, 2-3cm in the distal esophagus.

00:44 Once again, not like scleroderma where you would have increased fibrosis, but that would be more as I mentioned, uniformed. But here, by definition a peptic stricture is one in which by the distal esophagus as we get closer to the stomach, you might because of injury that’s taken place, result in fibrosis. Alkali, lye ingestion, injury, much greater acid with stricture formation at areas of physiologic narrowing. It increases the risk of squamous cell cancer. And what that basically is saying is the fact that if the patient is consuming some type of chemical that’s alkali in nature, stricture formation. Well, what you’re worried about here is the fact that the patient is developing squamous cell cancer. The reason that this is so important to you is because in the distal esophagus, most students and residents automatically think that it must be adenocarcinoma of the distal esophagus. Do not do that.

01:45 Pay attention to the history, the history and the history.

01:49 If there was a preceding event of reflux taking place chronically, then you go through the process of Barrett’s esophagus. And then, if there’s any type of cancer that you’re going to develop or the patient will develop, it’ll be adenocarcinoma of the esophagus. Where? Most likely distal.

02:08 That is definitely something that you want to know.

02:11 Along with this, because you can have peptic strictures down distally, if the irritation persists, then type of cancer that you’re developing is SCC, stands for squamous cell cancer of the esophagus.

02:25 Here, regardless, as the cancer and the tumour is growing in size, the dysphagia will be taking place with solids first, then liquids.

02:37 Progressive type.

02:39 Post-gastrectomy alkaline reflux can cause anastomotic strictures.

02:44 So, you have a patient that may have something like a bariatric surgery, and so therefore there might be indications for a gastrectomy.

02:54 Now, there might be alkaline reflux so therefore, resulting anastomotic type of strictures.

03:02 Treatment : Periodic dilation is basically all that you can do to manage your patient with strictures.

03:09 What we’re looking at here is an upper endoscopy.

03:12 So literally, you’re scoping the esophagus.

03:15 When you scope the esophagus, the fact that you find such disruption that you’re seeing here within the mucosa, and therefore causing narrowing of the caliber of your esophagus distally, making or presenting in the patient as being dysphagia. And if the issue is not properly managed and the irritation persists, unfortunately there’s every possibility this may then go on to a dysplasia. Worst case scenario, what kind of cancer distally here? Good.

03:50 Squamous cell cancer.