Compression Stenosis Of The Esophagus


Categories: DISEASES OF THE ESOPHAGUS
Sources: A Manual Of Peroral Endoscopy And Laryngeal Surgery

The esophagus may be narrowed by the pressure of any periesophageal

disease or anomaly. The lesions most frequently found are:

1. Goiter, cervical or thoracic.

2. Malignancy of any of the intrathoracic viscera.

3. Aneurysm.

4. Cardiac and aortic enlargement.

5. Lymphadenopathies. Hodgkins' disease.

Leukemia.

Lues.

Tuberculosis.

Simple infective adenitis.

6. Lordosis.

7. Enlargement of the left hepatic lobe.



Endoscopically, compression stenosis of the esophagus is manifested by

a slit-like crevice which occupies the place of the lumen and which

does not open up readily before the advancing tube. The long axis of

the slit is almost always at right angles to the compressive mass, if

the esophageal wall be uninvolved. The covering mucosa may be normal

or it may show signs of chronic inflammation. Malignant compressions

are characterized by their hardness when palpated with the tube.

Associated pressure on the recurrent laryngeal nerve often makes

laryngeal paralysis coexistent. The nature of the compressive mass

will require for its determination the aid of the roentgenologist,

internist, and clinical laboratory. Compression by the enlarged left

auricle has been observed a number of times. The presence of aneurysm

is a distinct contraindication to esophagoscopy for diagnosis except

in case of suspected foreign body.



Treatment of compressive stenosis of the esophagus depends upon the

nature of the compressive lesion and is without the realm of

endoscopy. In uncertain cases potassium iodid, and especially mercury,

should always be given a thorough and prolonged trial; an occasional

cure will result. Esophageal intubation is indicated in all conditions

except aneurysm. Gastrostomy should be done early when necessary.





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