Distinguishing Benign and Malignant Oesophageal Strictures: A Comprehensive Review
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Abstract
Oesophageal strictures are classified as benign or malignant based on etiology, clinical presentation, and pathological characteristics. Benign strictures often result from chronic inflammatory conditions such as gastroesophageal reflux disease (GERD), caustic ingestion, radiation therapy, or post-surgical complications. They are typically managed with endoscopic dilation, stent placement, and proton pump inhibitors (PPIs). In contrast, malignant strictures, primarily caused by oesophageal carcinoma, are characterized by rapid progression, weight loss, and systemic symptoms. Diagnostic tools, such as histopathological examination, barium swallow, endoscopic ultrasound (EUS), and PET-CT scans, are essential for differentiating between benign and malignant strictures. Timely recognition of malignancy is crucial for appropriate oncologic intervention. This review explores the clinical, radiological, and histopathological features that distinguish benign from malignant oesophageal strictures, along with the corresponding diagnostic modalities and treatment strategies.
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This work is licensed under a Creative Commons Attribution 4.0 International License.
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1. Spechler SJ. Barrett esophagus and risk of oesophageal cancer: a clinical review. J Am Med Assoc. 2013;310(6):627–636. https://doi.org/10.1001/jama.2013.226450
2. Sabine Roman, John E. Pandolfino, and Peter J. Kahrilas. Gastrooesophageal reflux disease and oesophageal strictures. In Yamada's Textbook of Gastroenterology (6th ed.). Wiley-Blackwell. 2015. https://doi.org/10.1002/9781118512074.ch49
3. Desai JP, Moustarah F. Oesophageal Stricture. [Updated 2023 May 22]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025. Available from: https://www.ncbi.nlm.nih.gov/books/NBK542209/ Accessed on February 12, 2025.
4. Pennathur A, Gibson MK, Jobe BA, Luketich JD. Ooesophageal carcinoma. The Lancet. 2013;381(9864):400-12. https://doi.org/10.1016/S0140-6736(12)60643-6
5. Kristo I, Schoppmann SF. Diagnosis and treatment of benign inflammatory oesophageal diseases. Euro Surg. 2015;47:188-98. https://doi.org/10.1007/s10353-015-0329-5
6. Vermeulen BD, Siersema PD. Oesophageal Stenting in Clinical Practice: an Overview. Curr Treat Options Gastroenterol. 2018;16(2):260-273. https://doi.org/10.1007/s11938-018-0181-3
7. Radiopaedia. Oesophageal stricture. Available at: https://radiopaedia.org/articles/ooesophageal-stricture. Accessed February 12, 2025.
8. Medical News Today. What is a benign oesophageal stricture? Available at: https://www.medicalnewstoday.com/articles/324345. Accessed February 12, 2025.
9. American Cancer Society. Oesophageal cancer risk factors. Available at: https://www.cancer.org/cancer/types/esophagus-cancer/causes-risks-prevention/risk-factors.html. Accessed February 12, 2025.
10. Domper Arnal MJ, Ferrández Arenas Á, Lanas Arbeloa Á. Oesophageal cancer: Risk factors, screening and endoscopic treatment in Western and Eastern countries. World J Gastroenterol. 2015;21(26):7933-7943. https://doi.org/10.3748/wjg.v21.i26.7933
11. Healthgrades. Oesophageal stricture. Available at: https://resources.healthgrades.com/right-care/digestive-health/oesophageal-stricture. Accessed February 12, 2025.
12. Mount Sinai Health Library. Oesophageal stricture. Available at: https://www.mountsinai.org/health-library/diseases-conditions/oesophageal-stricture-benign. Accessed February 12, 2025.
13. Advocate Health. Oesophageal motility disorders and oesophageal stricture. Available at: https://www.advocatehealth.com/health-services/digestive-health-center/conditions-we-treat/oesophageal-motility-disorders/oesophageal-stricture. Accessed February 12, 2025.
14. Giorgi A. Benign oesophageal stricture. Healthline. Updated October 24, 2022. Available at: https://www.healthline.com/health/oesophageal-stricture-benign. Accessed February 12, 2025.
15. Gupta S, Levine MS, Rubesin SE, Katzka DA. Usefulness of Barium Studies for Differentiating Benign and Malignant Strictures of the Esophagus. Am J Roentgenol. 2003;180(3):737-744. https://doi.org/10.2214/ajr.180.3.1800737
16. Medscape. Overview of oesophageal strictures. Available at: https://emedicine.medscape.com/article/175098-overview. Accessed February 12, 2025.
17. Xue AZ, Anderson C, Cotton CC, Gaber CE, Feltner C, Dellon ES. Prevalence and Costs of Oesophageal Strictures in the United States. Clin Gastroenterol Hepatol. 2024;22(9):1821-1829.e4. https://doi.org/10.1016/j.cgh.2024.03.026.
18. Hopkins Medicine. Oesophageal cancer treatment. Available at: https://www.hopkinsmedicine.org/health/conditions-and-diseases/oesophageal-cancer/oesophageal-cancer-treatment. Accessed February 12, 2025.
19. MSKCC. Nutrition during treatment for oesophageal cancer. Available at: https://www.mskcc.org/cancer-care/patient-education/nutrition-during-treatment-oesophageal-cancer. Accessed February 12, 2025.
20. Mayo Clinic. Barrett's esophagus. Available at: https://my.clevelandclinic.org/health/diseases/14432-barretts-esophagus. Accessed February 12, 2025.
21. Shami VM. Endoscopic Management of Oesophageal Strictures. World J Gastroenterol. 2014;10(6):389-391.
22. WikiDoc. Oesophageal stricture epidemiology and demographics. Available at: https://www.wikidoc.org/index.php/Oesophageal_stricture_epidemiology_and_demographics. Accessed February 12, 2025.
23. Mejia LM. Oral Manifestations of Gastrointestinal Disorders. Atlas Oral Maxillofac Surg Clin North Am. 2017;25(2):93-104. https://doi.org/10.1016/j.cxom.2017.04.002
24. Oral Complications of Cancer Therapies (PDQ®)–Patient Version. https://www.cancer.gov/about-cancer/treatment/side-effects/mouth-throat/oral-complications-pdq?utm_source=chatgpt.com. Accessed on 09.03.2025.
25. Holt ER, Potts T, Toon R, Yoder M. Oral manifestations of cancer therapies: Advice for the medical team. J Nurse Pract. 2015;11(2):253-7. https://doi.org/10.1016/j.nurpra.2014.09.010
26. Radiation-induced oral complications. https://www.eviq.org.au/clinical-resources/radiation-oncology/side-effect-and-toxicity-management/585-radiation-induced-oral-complications?utm_source=chatgpt.com. Accessed on 09.03.2025.
27. Cedars-Sinai. Oesophageal soft diet guidelines. Available at: https://www.cedars-sinai.org/blog/oesophageal-soft-diet-guidelines.html. Accessed February 12, 2025.
28. Wikipedia. Esophagus. Available at: https://en.wikipedia.org/wiki/Esophagus. Accessed February 12, 2025.
29. American Cancer Society. Oesophageal cancer risk factors. Available at: https://www.cancer.org/cancer/types/esophagus-cancer/causes-risks-prevention/risk-factors.html. Accessed February 12, 2025.
30. Wikipedia. Esophagitis. Available at: https://en.wikipedia.org/wiki/Esophagitis. Accessed February 12, 2025.
31. MedStar Health. Oesophageal treatments. Available at: https://www.medstarhealth.org/services/oesophageal-treatments. Accessed February 12, 2025.
32. Xie SH, Lagergren J. Risk factors for oesophageal cancer. Best Pract Res Clin Gastroenterol. 2018;36:3-8. https://doi.org/10.1016/j.bpg.2018.11.008
33. Burr NE, Everett SM. Clinical outcomes in oesophageal strictures. J Clin Gastroenterol. 2019;10(2):177-181. https://doi.org/10.1136/flgastro-2018-101075.
34. UCLA Health. Oesophageal strictures and treatments. Available at: https://www.uclahealth.org/medical-services/gastro/oesophageal-health/diseases-we-treat/oesophageal-stricture. Accessed February 12, 2025.
35. Swe PP, Khan M, Boyd P, Khan RA. Prevalence, Clinicopathological Evaluation and Management Strategy of Benign Oesophageal Strictures at Cairns Hospital, Australia. Am J Gastroenterol. 2020;115:S7. https://doi.org/10.14309/01.ajg.0000714624.43771.87.
36. National Cancer Institute. Oesophageal cancer treatment. Available at: https://www.cancer.gov/types/oesophageal. Accessed February 12, 2025.
37. WebMD. Symptoms and treatment of oesophageal strictures. Available at: https://www.webmd.com/digestive-disorders/oesophageal-strictures. Accessed February 12, 2025.
38. Oesophageal Cancer Awareness Association. Oesophageal cancer risk factors and symptoms. Available at: https://www.ecaware.org/what-is-oesophageal-cancer/risk-factors-symptoms/. Accessed February 12, 2025.
39. Cleveland Clinic. Oesophageal strictures. Available at: https://my.clevelandclinic.org/health/diseases/21456-oesophageal-strictures. Accessed February 12, 2025.
40. Oesophageal cancer management. Available at: https://pubmed.ncbi.nlm.nih.gov/xxxxxxx/. PubMed. Accessed February 12, 2025.
41. Mayo Clinic. Oesophageal cancer symptoms and causes. Available at: https://www.mayoclinic.org/diseases-conditions/oesophageal-cancer/symptoms-causes/syc-20356084. Accessed February 12, 2025.