Curbside Consultation in GI Cancer for the Gastroenterologist: 49 Clinical Questions

Douglas G. Adler, MD

Question 6: A 55-Year-Old Man Undergoes An Esophagectomy For Esophageal Cancer. Two Years Later, He Develops Dysphagia And A Contrast Study Discloses A Narrowing At His Anastomosis. How Should This Be Investigated And Treated? (continued)

Michael Walker, MD; John Fang, MD

In the above case, radiologic evaluation has identified a stricture at the anastomosis from the previous esophagectomy. The main differential for this finding is a benign anastomotic stricture versus a recurrent malignant stricture. Dysphagia due to anatomical narrowing usually requires approximately 50% occlusion of the esophageal lumen. Patients in this situation will initially have solid food dysphagia, with dysphagia for liquids indicating more severe narrowing. Other important signs and symptoms to inquire about include weight loss, chest pain, reflux, and aspiration. Most patients in…