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How can the caliber of a stenosis be evaluated?
H.W. Boyce (Tampa)
A careful history from the patient regarding the type of foods in the diet that cause dysphagia or the sensation of delay in passage of a specific food bolus provides a gross indication of the degree of stenosis. No patient is able to tolerate solid food eaten in a normal manner on a regular diet when the esophageal lumen diameter has been reduced to 13 mm or less. Many patients experience solid food dysphagia with only minimal esophageal stenosis [1].
The ingestion of medication in tablet or capsule form also can provide an estimate of lumen diameter when the pill impacts or passes the stenosis slowly. The most common clinical-radiographic procedure used to estimate functional esophageal lumen diameter is the use of a standard 12.5 mm barium tablet that passes through a normal esophagus in less than 20 seconds. Use of this tablet is helpful to assess the diameter and site of symptomatic esophageal obstruction. At best however a normal tablet transit provides information only that the lumen diameter is greater than 12.5 mm. Its passage does not help in assessing precise lumen diameter less than 12.5 mm. Lumen diameters greater than 13 mm up to 20 mm can be associated with solid food dysphagia and can be assessed further by using a larger bolus such as a marshmallow which will also produce a sensation of delay when its passage is impeded. However, the use of a compressible food bolus such as a marshmallow [2] does not allow very precise estimation of lumen diameter. Both the barium tablet and marshmallow bolus will dissolve and will not produce permanent impaction.
Tablets or barium-filled capsules in graded sizes with a diameter less than 12.5 mm may be used to evaluate the more severe degrees of stenosis. The diameter of the largest tablet that passes is used as the estimate of lumen size.
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