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.
4. Cardiac and aortic enlargement.
5. Lymphadenopathies. Hodgkins' disease.
Simple infective adenitis.
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.