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Schatzki's Ring: To Cut or Break an Unresolved Problem

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Abstract

Symptom assessment has been proven to be less reliable than barium pill testing for success of dilation of peptic strictures. Schatzki's ring also has a high recurrence rate. Our aim here was to compare the efficacy of single dilatation with a 54-F Savary dilator and electrosurgical ring incision for symptomatic Schatzki's rings. Schatzki's ring patients who failed to pass a 12.7-mm barium pill were randomized to dilatation with a 54-F Savary dilator or four quadrant incisions with a needle knife. All received lansoprazole (30 mg) for 30 days posttreatment. Follow-up at 1, 3, 6, and 12 months used the pill test and a dysphagia score. Eleven patients (mean age, 62; median, 64) were randomized and received therapy, six with dilatation and five with incision. The ring diameter pretherapy was 9.8 ± 1.3 mm. One patient with dilatation had a procedure-related esophageal perforation. The dysphagia score decreased (from 2.7 ± 1.1 predilatation and 3.0 ± 0.4 preincision) to 0 after treatment, suggesting that both therapies were equally successful. In contrast, using objective measurements with the barium pill showed that the pill failed to pass the ring in 60% at 1 month after therapy. The failure rate by 1 year was 100%. Use of an objective measure of effectiveness of treatment of symptomatic Schatzki's rings showed that neither single large-dilator dilatation nor four quadrant ring incision was a reliable and effective therapy. In the future studies, repeated dilatation may be needed to define success before long-term outcome can be accurately assessed.

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References

  1. Postlethwait RW, Sealy WC: Experiences with the treatment of 59 patients with lower esophageal web. Ann Surg 165:786-796, 1967

    Google Scholar 

  2. Postlethwait RW, Musser AW: Pathology of lower esophageal web. Surg Gynecol Obstet 120:571-575, 1965

    Google Scholar 

  3. Levine MS: Gastroesophageal junction. In Textbook of Gastrointestinal Radiology. Gore RM, Levine MS, Laufer I (eds). Philadelphia, W. B. Saunders, 1994, pp 531-541

    Google Scholar 

  4. Norton RA, King D: Steakhouse syndrome The symptomatic lower esophageal ring. Lahey Clinic Bull 13:55-59, 1963

    Google Scholar 

  5. Ott DJ, Chen YM, Wu WC, Gelfand DW, Munitz HA: Radiographic and endoscopic sensitivity in detecting lower esophageal mucosal ring. Am J Roentgenol 147:261-265, 1986

    Google Scholar 

  6. Schatzki R: The lower esophageal ring. Long term follow-up of symptomatic and asymptomatic rings. Am J Roentgenol Radium Ther Nucl Med 90:805-810, 1963

    Google Scholar 

  7. Bartlett MK, Jones DB: Surgical experience with the lower esophageal ring. Am J Surg 149:491-487, 1959

    Google Scholar 

  8. Chen YM, Gelfand DW, Ott DJ, Munitz HA: Natural progression of the lower esophageal mucosal ring. Gastrointest Radiol 12:93-98, 1987

    Google Scholar 

  9. Scharschmidt BF, Watts HD: The lower esophageal ring and esophageal reflux. Am J Gastroenterol 69:544-549, 1978

    Google Scholar 

  10. Eckardt V, Dagradi AE, Stempien SJ: The esophagogastric (Schatzki) ring and reflux esophagitis. Am J Gastroenterol 58:525-530, 1972

    Google Scholar 

  11. Eckardt VF, Kanzler G, Willems D: Single dilation of symptomatic Schatzki rings. A prospective evaluation of its effectiveness. Dig Dis Sci 37:577-582, 1992

    Google Scholar 

  12. Ott DJ: Radiographic techniques and efficacy in evaluating esophageal dysphagia. Dysphagia 5:192-203, 1990

    Google Scholar 

  13. Ott DJ, Kelley TF, Chen MY, Gelfand DW, Wu WC: Use of a marshmallow bolus for evaluating lower esophageal mucosal rings. Am J Gastroenterol 86:817-820, 1991

    Google Scholar 

  14. Mendl K, Evans CJ: Incomplete lower oesophageal diaphragm. Br J Radiol 35:165-171, 1962

    Google Scholar 

  15. Som ML, Wolf BS, Marshak RH: Narrow esophagogastric ring treated endoscopically. Gastroenterology 39:634-638, 1969

    Google Scholar 

  16. Groskreutz JL, Kim CH: Schatzki's ring: long-term results following dilation. Gastrointest Endosc 36:479-481, 1990

    Google Scholar 

  17. Eastridge CE, Pate JW, Mann JA: Lower esophageal ring: experiences in treatment of 88 patients. Ann Thorac Surg 37:103-107, 1984

    Google Scholar 

  18. Mossberg SM: Lower esophageal ring treated by pneumatic dilatation. Gastroenterology 48:118-121, 1965

    Google Scholar 

  19. Croteau JR, Geduldig MM: Roentgenographic appearance of symptomatic lower esophageal rings after pneumatic dilatation. Am J Roentgenol Radium Ther Nucl Med 110:278-287, 1970

    Google Scholar 

  20. Krevsky B, Pusateri JP Jr: Laser lysis of an esophageal web. Gastrointest Endosc 35:451-453, 1989

    Google Scholar 

  21. DiSario JA, Pedersen PJ, Bichis-Canoutas C, et al.: Incision of recurrent distal esophageal (Schatzki) ring after dilation. Gastrointest Endosc 56:244-248, 2002

    Google Scholar 

  22. Burdick JS, Venu RP, Hogan WJ: Cutting the defiant lower esophageal ring. Gastrointest Endosc 39:616-619, 1993

    Google Scholar 

  23. Raskin JB, Manten H, Harary A, et al.: Transendoscopic electrosurgical incision of lower esophageal (Schatzki) rings: a new treatment modality. Gastrointest Endosc 31:391-393, 1985

    Google Scholar 

  24. Guelrud M, Villasmil L, Mendez R: Late results in patients with Schatzki ring treated by endoscopic electrosurgical incision of the ring. Gastrointest Endosc 33:96-98, 1987

    Google Scholar 

  25. Ottinger LW, Wilkins EW Jr: Late results in patients with Schatzki rings undergoing destruction of the ring and hiatus herniorrhaphy. Am J Surg 139:591-594, 1980

    Google Scholar 

  26. Saeed ZA, Winchester CB, Ferro PS, et al.: Prospective randomized comparison of polyvinyl bougies and through-the-scope balloons for dilation of peptic strictures of the esophagus. Gastrointest Endosc 41:189-195, 1995

    Google Scholar 

  27. Saeed ZA, Ramirez FC, Hepps KS, et al.: An objective end point for dilation improves outcome of peptic esophageal strictures: a prospective randomized trial. Gastrointest Endosc 45:354-359, 1997

    Google Scholar 

  28. Schatzki R, Gary JE: Dysphagia due to a diaphragm-like localized narrowing in the lower esophagus “lower esophagus ring.” Am J Roentgenol Radium Ther Nucl Med 70:911-922, 1953

    Google Scholar 

  29. Goyal RK, Spiro HM: Lower esophageal ring. N Engl J Med 283:541, 1970

    Google Scholar 

  30. Chotiprasidhi P, Minocha A: Effectiveness of single dilation with Maloney dilator versus endoscopic rupture of Schatzki's ring using biopsy forceps. Dig Dis Sci 45:281-284, 2000

    Google Scholar 

  31. Vansant JH: Surgical significance of the lower esophageal ring. Ann Surg 175:733-739, 1972

    Google Scholar 

  32. Zaveri JP, Nathani RR, Shah RL: Schatzki's ring: an obscure cause of dysphagia (a case report). J Postgrad Med 33:99-101, 1987

    Google Scholar 

  33. Goyal RK, Bauer JL, Spiro HM: The nature and location of lower esophageal ring. N Engl J Med 284:1175-1180, 1971

    Google Scholar 

  34. Marshall JB, Kretschmar JM, Diaz-Arias AA: Gastroesophageal reflux as a pathogenic factor in the development of symptomatic lower esophageal rings. Arch Intern Med 150:1669-1672, 1990

    Google Scholar 

  35. Jamieson J, Hinder RA, DeMeester TR, et al.: Analysis of thirty-two patients with Schatzki's ring. Am J Surg 158:563-566, 1989

    Google Scholar 

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Authors and Affiliations

  1. Department of Medicine, Alexandria University, Alexandria, Egypt

    Abeer Ibrahim

  2. Department of Medicine, VA Medical Center and Baylor College of Medicine, Houston, Texas, USA

    Rhonda A. Cole, Waqar A. Qureshi, Ahmed Z. Helaly, Ali Jamecci, David Y. Graham & Kamran Ayub

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  1. Abeer Ibrahim
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  2. Rhonda A. Cole
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  3. Waqar A. Qureshi
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  4. Ahmed Z. Helaly
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  5. Ali Jamecci
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  6. David Y. Graham
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  7. Kamran Ayub
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Ibrahim, A., Cole, R.A., Qureshi, W.A. et al. Schatzki's Ring: To Cut or Break an Unresolved Problem. Dig Dis Sci 49, 379–383 (2004). https://doi.org/10.1023/B:DDAS.0000020489.96582.cd

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  • DOI: https://doi.org/10.1023/B:DDAS.0000020489.96582.cd

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