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Esophageal rings and webs

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 Canadian Association of Gastroenterologists (CAG 2018), the British Society of Gastroenterology (BSG 2018), the American Society for Gastrointestinal Endoscopy (ASGE 2014), and the American College of Gastroenterology (ACG 2013).


1.Diagnostic investigations

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

  • CT

  • Upper gastrointestinal endoscopy

2.Diagnostic procedures

Esophageal biopsy: consider performing distal, mid, and proximal esophageal biopsies in patients with symptomatic Schatzki ring to exclude eosinophilic esophagitis.

3.Medical management

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

4.Therapeutic procedures

Endoscopic dilation, indications, BSG
Do not perform esophageal dilation in patients with asymptomatic Schatzki rings incidentally discovered on diagnostic endoscopy or contrast studies (obtained for unrelated indications).
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.

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  • Endoscopic dilation (patient selection and preparation)

  • Endoscopic dilation (technical considerations)

  • Endoscopic dilation (personnel and setting requirements)

5.Surgical interventions

Electrosurgical incision
Consider performing electrosurgical incision as an alternative treatment to esophageal dilation to relieve dysphagia related to Schatzki ring.
Consider performing incision in patients with refractory Schatzki ring and anastomotic strictures at centers experienced in such techniques.

6.Patient education

Pre-dilation counseling: counsel all patients about the benefits and risks of dilation and the possible need for multiple sessions before symptom resolution.
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7.Follow-up and surveillance

Post-dilation assessment: 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.
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