A stricture in proximal esophagus may develop following radiation therapy for head and neck cancer. Early diagnosis can help reduce emotional distress and physical debility. The authors are from Karolinska Hospital and Stockholm University in Sweden.


Patients received high dose radiation therapy with delivery involving the proximal esophagus. The authors found delivery of a mean dose of 65 Gy to the proximal 2 cm and a mean dose of 60 Gy to the proximal 5 cm of the esophagus.


Onset is usually several months after radiation therapy, but ranges from a few weeks to several years.



(1) impaired swallowing, which is persistent or progressive after onset

(2) progressive weight loss



(1) X-rays while swallowing barium contrast material

(2) endoscopic examination



Grade of Stricture

moderate stricture with a fibrous membranous ring or moderate fibrosis


severe stricture with severe fibrosis


complete obliteration of the lumen



Differential diagnosis:

(1) tumor progression with neoplastic stricture

(2) neurologic impairment

(3) depression and/or anorexia related to cancer



(1) Mild to moderate strictures may respond to repeated dilation using Savary dilators.

(2) Severe stricture may require placement of a nasogastric or PEG tube.


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