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Schatzki Ring Sab & SKF

Foreign Body Ingestion

  • Risk: Iatrogenic perforation can occur if mishandled.
  • Preferred approach: Endoscopy under general anesthesia for lodged objects.
  • Management techniques:
    • Full relaxation, lubrication, and gentle pressure may help.
    • Use of large endoscopic graspers, nets, or lassoes for proximal removal.
    • Over-tubes and rigid esophagoscopy are frequently useful.
    • If not retrievable, laparoscopy/laparotomy with gastrotomy may be required.
    • Full GI evaluation with radiographs and CT scan before intervention.
  • Psychiatric evaluation: Needed for patients with recurrent foreign body ingestion or self-harm.

Benign Tracheoesophageal Fistula (TEF)

  • Causes: Multiple procedures, foreign bodies in the upper mediastinum, endotracheal tube or tracheostomy with nasogastric tube.
  • Symptoms: Recurrent respiratory infection, bilious/salivary content from tracheostomy.
  • Diagnosis: CT scan, barium swallow, followed by bronchoscopy and endoscopy.
  • Treatment principles:
    1. Discontinue causative agent (e.g., deflate/remove tracheostomy balloon).
    2. Consider exclusion of the fistula by stent or diversion.
    3. Repair when the patient is stable.
  • Surgical repair: Thoracotomy or cervical approach with resection of fistula and vascularized tissue interposition.
  • Esophageal and airway stents (kissing stents) may be used in severe cases but have risks.

Schatzki Ring

  • Description: Concentric, nonmalignant fibrous narrowing of the gastroesophageal junction (GEJ).
  • Histology: Squamous epithelium above, columnar cells below.
  • Association: Frequently seen with hiatal hernia and reflux disease.
  • Symptoms: Dysphagia or obstruction in symptomatic patients.
  • Diagnosis: Esophagram or endoscopy.
  • Treatment:
    • Dilatation with bougie or balloon.
    • Biopsy to rule out malignancy.
    • Repeated dilatation often necessary.
    • Persistent strictures warrant investigation for malignancy.

SKF on Shatzki ring

Esophageal Rings and Webs

Mucosal Ring

  • Description: A short, diaphragm-like, circumferential indentation, 2 to 3 mm thick, located at the junction of esophageal squamous epithelium (above) and columnar gastric epithelium (below).
  • Association: Often seen with a hiatal hernia when the esophagus and stomach are well distended.
  • Luminal Diameter:
    • >2 cm: Typically asymptomatic.
    • <20 mm: May cause dysphagia.
    • <14 mm (Schatzki ring): Symptomatic, associated with dysphagia and food impaction.
  • Schatzki Ring: Should be used for stenotic mucosal rings <14 mm, idiopathic, and not directly related to reflux esophagitis.

Esophageal Web

  • Location: Found in the cervical esophagus, just below the cricopharyngeal muscle.
  • Shape: U-shaped, indenting the anterior and lateral walls, sparing the posterior wall.
  • Thickness: Typically 1 to 2 mm, generally does not narrow the esophageal lumen significantly.
  • Symptoms: Usually asymptomatic.
  • Association: Classic association with Plummer-Vinson (Paterson-Kelly) syndrome (iron deficiency, splenomegaly, predisposition to hypopharyngeal and esophageal cancer) is questioned due to frequent incidental findings in healthy individuals.

Differentiation

  • Esophageal Webs: Differentiate from ectopic gastric mucosa, which produces two lateral indentations and is asymptomatic.