Barium evaluation of esophageal strictures: still useful or a bust?: Gupta S, Levine MS, Rubesin SE, et al., Usefulness of barium studies for differentiating benign and malignant strictures of the esophagus. Am J Roentgenol 2003;180:737—44

Ott, David J.
November 2003
American Journal of Gastroenterology;Nov2003, Vol. 98 Issue 11, p2563
Academic Journal
The purpose of this investigation was to determine the usefulness of barium radiological studies for differentiating benign and malignant strictures of the esophagus. Esophageal radiology has proved to be a useful technique for demonstrating luminal narrowing as a cause of dysphagia, with reported sensitivities exceeding 95% for the detection of strictures . In this retrospective study, a search of the radiological and endoscopic records revealed 100 patients (50 women and 50 men, mean age 61 yr) with esophageal strictures who had both examinations. Of these patients, 74 presented with dysphagia, and endoscopic tissue sampling was performed in 57.The images from the barium studies (all digital fluoroscopy) were reviewed by two GI radiologists who were blinded to the clinical, endoscopic, and pathological findings. The strictures seen on the radiological images were classified into three categories: 1) benign, 2) malignant, and 3) equivocal in appearance. The quality of the examinations was also graded; 94 patients had double-contrast studies, and the remaining six patients had only single-contrast examinations. The radiographic data were correlated with the endoscopic and pathological findings to determine the usefulness of barium studies for differentiating benign strictures from malignant tumors.Of the 100 esophageal strictures detected on barium studies, 75 strictures (75%) had a benign radiographic appearance, 11 (11%) had a malignant appearance, and 14 (14%) had an equivocal appearance. Of the 75 strictures that were presumed to be benign on radiographic examination, none had malignant tumor shown by endoscopy; 48 patients had benign strictures on endoscopy, whereas the remaining 27 patients did not show definite strictures. All 11 patients (i.e., 100%) with strictures that were presumed to be malignant on barium studies had malignant tumor on endoscopy (squamous carcinomas in five patients, adenocarcinomas in four, and other malignancies in two). Finally, 13 of 14 patients (93%) with strictures that were equivocal in appearance radiologically had benign strictures without tumor on endoscopy and one patient (7%) had esophageal carcinoma. The authors conclude that benign esophageal strictures depicted on barium examination do not warrant endoscopy to exclude malignancy. However, radiographically malignant or equivocal strictures require early endoscopy and biopsy for a definitive diagnosis.


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