A SYNDROME OF UPPER ESOPHAGEAL STENOSIS

Abstract

Neoplastic, stenotic lesions of the esophagus, or other pathologic disruptions which resemble them, tend to fall into 2 symptom complexes depending upon their location in the uppermost J or lowermost 2/3 of the esophagus. 30 consecutive cases were analyzed. 13 (43.3%) lay in the upper 1/3 17 (56.7%) in the lower 2/3. 12 patients of the 1st group died. All are said to have died of aspiration pneumonia. In 9 cases (69.2%) aspiration was confirmed fluoro-scopically during life by demonstrating overflow of Ba from the obstructed esophagus into the respiratory tree. Another 2 (15.4%) aspirated via fistulae. Vocal cords were examined in 12 patients. 11 (91.6%) showed paralysis or paresis of one or both cords. Clubbed fingers were present in 38.5% and were predicated on pulmonary pathology due to aspiration. Pulmonary complications were present, but greatly reduced in the 2d group. Only one (5.9%) showed aspiration fiuoroscopically; one (5.9%) fistula. Good vocal cord function contrasted with the 1st group, only one case showing weakness. Clubbed fingers were fewer, only 3 pts. (17.7%) demonstrating this sign. Recurrent laryngeal n. involvement, overflow aspiration, pulmonary complications, clubbed fingers, all fall into the syndrome of upper esophageal stenosis. Any of these may be present with lesions in the lower esophagus, but the incidence and constancy drop sharply. Although the lesions studied were mainly neoplastic it would appear that any combination of factors which resulted in similar anatomic or physiologic dysfunction might be expected to lead to similar complications.