What are oesophageal rings and webs ?

What is an oesophageal ring and web?

Oesophageal ring is a thin film of tissue that protrudes into the oesophagus. The usually occur high up in the oesophagus, in the throat region

 

Oesophageal ring is a circular ring within the wall of the oesophagus that protrudes into its lumen. They usually occur in the lower oesophagus. Schatzki ring is an example of an oesophageal ring. 

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What causes oesophageal rings and webs?

The cause of oesophageal webs are unknown. Rings are thought to occur when there is chronic acid exposure from reflux. It is possible that they are congenital. 

What are the symptoms?

Most rings and webs are asymptomatic. The symptoms that can occur include:

  • Difficulty swallowing particularly to solids
  • Symptoms can be intermittent
  • Often patient mention the need to chew food more thoroughly
  • Burning sensation in the chest- reflux

How are oesophageal rings and webs diagnosed?

  • Primarily diagnosed when a thin tube with a camera (endoscope) is used to look inside the oesophagus. This is usually performed when patients experience difficulty swallowing. On endoscopy a web appears as a thin membrane which is not circumferential. With oesophageal rings, a thin membrane that is circumferential can be seen and is usually seen with a hiatus hernia. There may also be evidence of inflammation of the oesophagus. 
  • Barium swallow can be performed which is when the patient is asked to swallow a dye and serial x-rays are performed. This will identify a narrowing in the oesophagus

What are the treatment options?

If the patient is a symptomatic, no treatment is needed. If the patient has symptoms the following treatment options are available

  • Endoscopy and dilation can be performed at the same time. With oesophageal rings, biopsies should be taken as well. In patients with oesophageal rings, a proton pump inhibitor should be started immediately after dilation
  • In patients where symptoms recur, repeat endoscopy and dilation can be attempted. A balloon can be inflated in the oesophagus at the time of endoscopy to help with dilation
  • Endoscopic incisional electrocautery therapy can also be performed. This is where an incision can be made into the ring using electrocautery to make the oesophagus wider

What are the risks of treatment?

  • Infection
  • Pain
  • Intra or post procedure bleeding
  • Persistence of symptoms and need for further surgery/procedure
  • Scarring and narrowing of the oesophagus also known as strictures
  • Oesophageal perforation
  • Need for surgery in the instances of perforation
  • Complications related to a prolonged operation/anaesthetic including clots in the legs, lungs, brain or heart.

How long will I be in hospital and what is the recovery period and follow up?

Depending on the procedure performed the course of recovery is as follows:

  • Tends to be day case procedures
  • Liquids only immediately after the procedure is recommended
  • Following day 1 the diet is slowly built to a soft diet and progressed to a normal diet over 2-3 weeks. 
  • Patients will be followed up 4-6 weeks after the procedure.

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