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Esophageal rings and webs

Guidelines

Key sources

The following summarized guidelines for the evaluation and management of esophageal rings and webs are prepared by our editorial team based on guidelines from the American College of Radiology (ACR 2019), the British Society of Gastroenterology (BSG 2018), the Canadian Association of Gastroenterologists (CAG 2018), the American Society for Gastrointestinal Endoscopy (ASGE 2014), and the American College of Gastroenterology (ACG ...
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Diagnostic investigations

History and physical examination
As per CAG 2018 guidelines:
Elicit a history to help differentiate between structural and motility disorders of the esophagus in patients with suspected esophageal dysphagia.
B
Assess for alarm features requiring urgent investigations in patients with esophageal dysphagia to ensure timely referral for appropriate management.
B
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  • Barium esophagram

  • CT

  • Upper gastrointestinal endoscopy

Diagnostic procedures

Esophageal biopsy: as per BSG 2018 guidelines, consider performing distal, mid, and proximal esophageal biopsies in patients with symptomatic Schatzki ring to exclude eosinophilic esophagitis.
B

Medical management

PPIs: as per BSG 2018 guidelines, initiate PPI therapy after esophageal dilation to reduce the risk of relapse of Schatzki ring.
B

Therapeutic procedures

Endoscopic dilation, indications
As per BSG 2018 guidelines:
Do not perform esophageal dilation in patients with asymptomatic Schatzki rings incidentally discovered on diagnostic endoscopy or contrast studies (obtained for unrelated indications).
D
Perform a single dilation session using graded dilation to a relatively large diameter (16-20 mm) for the treatment of dysphagia related to Schatzki ring.
B

More topics in this section

  • Endoscopic dilation (patient selection and preparation)

  • Endoscopic dilation (technical considerations)

  • Endoscopic dilation (personnel and setting requirements)

Surgical interventions

Electrosurgical incision
As per BSG 2018 guidelines:
Consider performing electrosurgical incision as an alternative treatment to esophageal dilation to relieve dysphagia related to Schatzki ring.
B
Consider performing incision in patients with refractory Schatzki ring and anastomotic strictures at centers experienced in such techniques.
C

Patient education

Pre-dilation counseling: as per BSG 2018 guidelines, counsel all patients about the benefits and risks of dilation and the possible need for multiple sessions before symptom resolution.
B
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Follow-up and surveillance

Post-dilation assessment: as per BSG 2018 guidelines, monitor patients for at least 2 hours in the recovery room after the procedure and provide clear written instructions with advice on fluids, diet, and medications.
B
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