Chronic esophageal stricture with Barrett's esophagus.

A 51-year-old man presented to the Center for Voice and Swallowing complaining of solid-food dysphagia and pyrosis. Transnasal esophagoscopy (TNE) revealed a narrow midesophageal stricture (figure, A). Because the 5.1-mm endoscope could not be passed through the narrowed lumen, the patient underwent unsedated balloon dilation over a guide wire to 15 mm under TNE guidance (figure, B). After dilation, the squamocolumnar junction could be seen in the proximal esophagus, indicating the presence of Barrett's metaplasia (figure, C). Biopsy of the distal esophageal mucosa revealed long-segment Barrett's metaplasia with high-grade dysplasia up to the level of the stricture.

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In Barrett's esophagus, the normal squamous cell epithelium of the esophagus is replaced with intestinal-type columnar epithelium. Both esophageal strictures and Barrett's esophagus have been associated with gastroesophageal reflux disease. Long-segment Barrett's esophagus is defined as a stricture 3 cm or longer, and the risk of developing esophageal adenocarcinoma rises with increasing length. As the degree of dysplasia increases, the risk of esophageal adenocarcinoma also increases. In high-grade dysplasia, the risk of esophageal adenocarcinoma is approximately 25%.

The treatment for high-grade dysplasia in Barrett's esophagus is esophageal resection, experimental mucosal ablation, or intensive endoscopic monitoring with biopsies.

Suggested reading

Gopal DV, Lieberman DA, Magaret N, et al. Risk factors for dysplasia in patients with Barrett's esophagus (BE): Results from a multicenter consortium. Dig Dis Sci 2003;48:1537-41.

Schuchert MJ, McGrath K, Buenaventura PO. Barrett's esophagus: Diagnostic approaches and surveillance. Semin Thorac Cardiovasc Surg 2005;17:301-12.

Catherine J. Rees, MD; Peter C. Belafsky, MD, PhD

From the Center for Voice and Swallowing, University of California--Davis, Sacramento, Calif.