Benign Stricture is our topic.
Benign Stricture : Peptic, caustic
or anastomotic mucosal injury.
So there’s a number of things that
are causing injury to the esophagus.
Whenever there’s injury
begin the repair process.
So therefore, there might be fibrosis.
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.
And that stricture formation making it more
difficult for food particles to then move forward.
Peptic strictures are smooth and
short, 2-3cm in the distal esophagus.
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.
Pay attention to the history,
the history and the history.
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.
Most likely distal.
That is definitely something
that you want to know.
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.
Here, regardless, as the cancer
and the tumour is growing in size,
the dysphagia will be taking place
with solids first, then liquids.
Post-gastrectomy alkaline reflux
can cause anastomotic strictures.
So, you have a patient that may have
something like a bariatric surgery,
and so therefore there might be indications for a gastrectomy.
Now, there might be alkaline reflux so therefore,
resulting anastomotic type of strictures.
Treatment : Periodic dilation is basically all that
you can do to manage your patient with strictures.
What we’re looking at here
is an upper endoscopy.
So literally, you’re
scoping the esophagus.
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?
Squamous cell cancer.