UpToDate - Esophageal Strictures, Dilation, Complications, Iatrogenic Esophageal Perforation Flashcards
Most nonmalignant esophageal strictures result from what and are managed how?
GERD.
Managed w/ endoscopic dilation and medical therapy w/ acid suppression.
How do you classify esophageal strictures?
Simple or complex.
Simple - smooth, <2cm, straight, concentric, allow endoscope passage. Peptic strictures are usually simple.
Complex (any one) - >2cm, angulated, irregular, severely narrowed (<10 mm); assd w/ large hiatal hernia (5 cm), w/ esophageal diverticula, or TEF.
In terms of general intervention management, how would you manage a complex esophageal stricture differently than a simple one?
Guidewire-based system
How would you define a refractory stricture?
Unable to dilate to a diameter of 14mm over 5 endoscopic sessions (occurring at 2 week intervals).
Describe the patient with eosinophilic esophagitis.
Young patient with hx of food impaction.
What are contraindications for endoscopic interventions for nonmalignant esophageal strictures?
Can’t tolerate mod sedation/MAC/gen anesthesia.
Acute or incompletely healed esophageal perforation.
Disorders of hemostasis (plt 50K, INR 1.5).
HD instability.
Erosive esophagitis d/t uncontrolled GERD or recent food impactions. Defer intervention until underlying condition has been treated. and the mucosa has healed.
Eosinophilic esophagitis suspected but not confirmed/not treated.
How do you grade esophagitis?
LA classification - extent of mucosal abnormality, with complications recorded separately.
A - one or more mucosal breaks <5mm in length.
B - 1 or more break >5 mm, but not continuous b/w the tops of adj mucosal folds.
C - 1 or more break continuous b/w the tops of adj mucosal folds, but not circumferential.
D - mucosal break that involves at least three-fourths of the luminal circumference.
