Esophageal Web

 

General Considerations

  • Mucosal shelf projecting into the lumen of the esophagus most frequently from the anterior wall of proximal cervical esophagus at the level of cricopharyngeus (C5-C6)
    • Uncommon in distal esophagus
  • Usually seen in middle-aged adults, females greater than males
  • May or may not contain submucosa
  • Cervical webs may be congenital, idiopathic (normal variant) or due to prior inflammation and scarring
  • Distal esophageal webs are usually the sequelae of inflammation such as from EG reflux

Clinical Findings

  • Mostly asymptomatic
  • May present with dysphagia
  • Food may impact above web

Imaging Findings

  • May be shelf-like to circumferential in proximal cervical esophagus on swallowing study
  • Most easily seen on videofluoroscopic esophagram, usually in lateral projection
  • 1-2 mm wide
  • Luminal narrowing may be absent or severe

Differential Diagnoses

  • Esophageal strictures
    • Longer than webs
  • Schatzki ring
    • Lower (GE junction) esophageal mucosal or Β ring
  • Cricopharyngeal achalasia
    • Larger, rounded protrusion from posterior pharyngeal wall at  pharyngoesophageal junction (C5-6 level)

Associations

  • May  be associated with Plummer-Vinson (Paterson-Kelly) syndrome
  • Eosinophilic esophagitis
  • Celiac-sprue disease
  • Chronic gastroesophageal reflux

Treatment

  • Balloon dilation or bougienage during esophagoscopy

Prognosis

  • Good 

 

cervical esophageal web

Cervical esophageal web. There is a linear, shelf-like filling defect (white arrow)
on the anterior aspect of the cervical esophagus at the level of C5-C6 on this still frame
of a video swallowing function study.
For this same photo without the arrow, click here
For more information, click on the link if you see this icon

       

Rees CJ et al: Upper esophageal web. Ear Nose Throat J. 86(12):732, 2007

Nosher JL et al: The clinical significance of cervical esophageal and hypopharyngeal webs. Radiology. 117(1):45-7, 1975

Clements JL Jr et al: Cervical esophageal webs--a roentgenanatomic correlation. Observations on the pharyngoesophagus. Am J Roentgenol Radium Ther Nucl Med. 121(2):221-31, 1974