Benign structural narrowing of the esophageal lumen can result in dysphagia, which is typically managed with en-doscopy-guided dilation. The type of obstructive process (eg, stricture, ring, or uninhibited muscle contraction) can determine the technique as well as goals of dilation, making adequate visualization and recognition of the obstructive process essential. Barium esophagrams have a higher sensitivity for detecting subtle lesions that leave the luminal opening at least 10 mm in diameter, especially when a barium-impregnated solid or semisolid bolus is used.1 To obtain the most accurate endoscopic identification of a distal esophageal stricture or ring, patience is key. With the tip of the endoscope in the distal esophagus, air is gently insufflated for optimal distension to enhance detection of a subtle narrowing. Secondary esophageal peristaltic waves may disrupt the effort, and perseverance through failed attempts is required. Other benign obstructive processes include sphincter relaxation errors and obstructive, nonperistaltic distal esophageal contractions, which are most commonly diagnosed by motility testing when endoscopy or barium studies fail to produce a diagnosis. Yet dysphagia does not always lead to a diagnosis of an obstructive process; dysphagia can also arise from mucosal inflammation, as seen with reflux, infectious or pill esopha-gitis, or from heightened visceral perception (functional dysphagia).
展开▼
