The use of endoscopy in assessment and treatment peptic strictures of the esophagus.
In the 1960s, evaluation of peptic strictures of the esophagus was a significant and difficult clinical problem. The use of rigid esophagoscopes and general anesthesia resulted in high complication rates. Most peptic esophageal strictures were managed surgically. The 1970s brought a dramatic change in the management of peptic strictures of the esophagus. With the introduction and widespread use of the forward-viewing, flexible panendoscope for upper gastrointestinal (GI) endoscopy, general anesthesia is no longer needed; evaluation of the peptic stricture has become one of the most common procedures in GI endoscopy. From December 1975 to October 1982, 1000 dilations were performed with a morbidity of 0.2 per cent and a mortality of 0.1 per cent. Initially, radiographic evaluation proximal to, distal to, and at the stricture is conducted. Endoscopic evaluation of the same three areas is then performed with emphasis on determining whether the stricture is benign or malignant. Malignancy can be determined visually in more than 90 per cent of the patients and in more than 95 per cent of the patients with multiple biopsies and cytology. Immediate dilation, using rubber (Maloney) dilators (Pilling Medical Co., Fort Washington, PA) or Eder-Puestow dilators (Eder Instrument Co., Chicago, IL), is then performed. The personality of the stricture determines which dilator can be used with greatest safety.
D001706:Biopsy; D003251:Constriction, Pathologic; D004106:Dilatation; D004724:Endoscopy / Q000379:methods*; D004938:Esophageal Neoplasms / Q000175:diagnosis; D004942:Esophagitis, Peptic / Q000175:diagnosis / Q000000981:diagnostic imaging / Q000628:therapy*; D006801:Humans; D011859:Radiography