A 54-year-old man was referred to our hospital with a history of high non-progressive dysphagia to solid food, meat impaction and ~8 kg of weight loss over last ten months because low intake on account of dysphagia as his appetite was normal. He denied heartburn, acute caustic ingestion, any history of chest pain, vomiting or loss of appetite. His medical history and family history (including atopic disease) were unremarkable as well as physical examination; in particular, the patient has no anemia, koilonychia, glossitis or stomatitis.
Basic biochemical tests and complete blood count were normal (white blood cell count: 9730/mm3, eosinophils: 70/mm3, hemoglobin level: 14.2 g/dl, mean corpuscular volume: 91.7 fL, serum iron level: 91 mcg/dL and ferritin level: 113 mg/L). Antigliadin and antiendomysial antibodies for celiac disease were negative.
We performed a barium swallow esophagram that showed two linear, circumferential filling defects on the anterior aspect of the cervical esophagus, consisting with the diagnosis of esophageal webs (Figure 1). Likewise, upper gastrointestinal endoscopy confirmed the presence of the cervical webs at 17 cm from the incisors with the endoscope not able to pass through (Figure 2). In order to exclude any other causes of dysphagia, computed tomography was performed. This revealed no abnormality around the esophagus, such as a tumor or swollen lymph nodes, which can cause luminal stenosis.
Thus, other causes of cervical esophageal webs were ruled out, including motility disorders, celiac disease, PVs syndrome, Zenker diverticulum, benign or malignant tumors or extrinsic compression of esophagus.
The treatment consisted of endoscopic balloon dilation without any complications (Figure 3). We used the Boston Scientific CRE Wireguided Balloon Dilation Catheter with the size 15 - 16.5-18 mm, who was inflated to 7 atm, the pressure needed to obtain an 18 mm diameter. Only one dilation was performed with excellent clinical and endoscopic results. After this procedure the patient's dysphagia resolved immediately and the endoscope passed easily in through the esophagus showing normal esophageal, gastric and duodenal mucosa.
At the first follow-up, twelve months after endoscopic ballon dilation, the patient gained weight and he had no complains. Likewise, he remained asymptomatic and did not show any recurrence for three years. A second procedure was not considered necessary by the medical personnel or the patient during the follow-up.