Management of proximal oesophageal stricture

Thirty-two patients with proximal oesophageal stricture who were treated under one surgeon (K.M.) during a 17-year period are reviewed. The cause of the stricture in these cases was widely varied and included: gastro-oesophageal reflux (Barrett-type oesophagus), radiotherapy and post-surgical anastomosis following oesophageal reconstruction. Seventeen patients were treated by repeated endoscopic dilatation. Of the remaining 15, 3 patients only (1 with suspected malignancy and 2 with occult cancer) needed resection and reconstruction of the oesophagus. Twelve patients underwent simple conservative operations. There was no hospital or treatment related mortality in this series. We concluded that the majority of such strictures respond to repeated endoscopic dilatation or conservative surgical operation. It is mandatory to exclude malignancy in obstructive lesions of the proximal oesophagus and it is important to establish the aetiology of the lesion in order to undertake the most appropriate treatment.