Endoscopic signs of esophageal strictures

Under stricture we mean a clearly delimited constriction that does not stretch under the pressure of the air. In 70-73% of cases, esophageal stricture occurs as a result of chemical burns of the esophagus. In other cases, strictures develop as a result of reflux-esophagitis, radiation therapy for thyroid cancer, and damage to the esophagus during operations. Strictures develop if the muscular layer of the esophagus is affected. The degree of constriction depends on the concentration of the solution, the extent of the lesion, and the state of immunity.

Classification of esophageal strictures (Ratner).

1. On localization of stricture.
   1. High strictures. In the area of the entrance to the esophagus and the cervical region.
   2. Median strictures. The lower part of the cervical region, the area of the arch of the aorta and the bifurcation of the trachea.
   3. Low strictures (cardial).
   4. Combined strictures.
2. By the extent of the defeat.
   1. Short (membranous or membranous). One scar in the form of a fold.
   2. Circular. The length is up to 3 cm.
   3. Tubular. The length is more than 3 cm.
   4. Clearly. Alternation of narrowed sections with normal ones.
   5. Total defeat of the esophagus.
3. In the form of a suprastenotic enlargement.
   1. Conical.
   2. Sacred.
4. For complications.
   1. False diverticula.
   2. False moves.
   3. Cicatricial shortening.
   4. Fistula.

Classification of the degree of obstruction of the esophagus.

1. Electoral. The diameter of the constriction is 1.0-1.5 cm. Almost all food passes except rough.
2. Compensated. The diameter of the constriction is 0.3-0.5 cm. Semi-fluid and carefully processed food passes through. Appears suprastenotic expansion of the esophagus.
3. Subcompensated. The diameter is less than 0.3 cm. Only liquid and oil pass.
4. Reversible. Complete violation of the passage of food and fluid through the esophagus, but after the course of treatment, patency is restored.
5. Full obliteration.

Classification by the nature of the inflammatory process in the field of stricture.

• Epithelial strictures:
  • without inflammatory process,
  • catarrhal esophagitis,
  • fibrinous esophagitis,
  • erosive esophagitis.
• Non-epithelial strictures:
  • catarrhal-ulcerative esophagitis,
  • erosive-ulcerative esophagitis.

Inspection begins with an ordinary apparatus, which can be replaced, if necessary, by an infantile device, a choledochoscope, a bronchoscope, or a babybikop (diameter 2.4 mm) can be used. The length of the lesion is determined by a farscept, using a babyscope. The diameter of the constriction is determined or guided by the diameter of the apparatus, or using the balloon method.

Stricture looks like a dense cicatrix funnel, rounded, oval or rectangular in shape, the lumen can sometimes be covered by a fold of unaltered mucosa. A clear transition of the unmodified mucosa to the stricture is seen. With strictures with a clearance of less than 0.6 cm, epithelium is absent for a month after the burn. This stricture is covered with a thick coating of fibrin. After its removal, bright red (scar tissue) is exposed, bleeding, less often pale walls (mature scar tissue).

Criteria for distinguishing cicatricial strictures from cancerous

1. For cicatricial strictures, stretching of the stricture wall is characteristic when air insufflation.
2. For cicatricial strictures, a clear transition from normal mucosa to scar tissue is characteristic.
3. The form of narrowing with cicatricial strictures is round or oval.
4. With cancerous narrowing when biopsies are taken - great difficulties - a tissue of cartilaginous density.

Epithelialized cicatricial strictures with a narrowing diameter of more than 0.6 cm. Epithelial lining pale, soldered to the underlying tissues. With air insufflation, the walls of the stricture are partially stretched in contrast to cancer. Cancer in cicatricial stricture resembles proliferation of granulations, but not red, but white-gray, dense with instrumental palpation. A biopsy should be taken from granulations.

Features of ulcers in cicatricial strictures

1. The infiltrative shaft around the ulceration is absent.
2. The border of the ulcer is represented by an epithelial lining, hyperemic along the edge and soldered to the underlying scar tissue.
3. The surface of ulcers is even, clear, there is fibrinous plaque.
4. Ulcers of round, oval or polygonal shape.

At a later date (more than 1.5 months), a dense, white scar tissue is visible.

[1], [2], [3], [4], [5], [6], [7]