An Unusual Case of Significant Cervical Esophageal Stricture

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Question: A 65-year-old man was referred to our facility for solid-food dysphagia without other disease history. He lived a happy and healthy life without abuse of alcohol or tobacco. The symptom started about 2 years before, without accompanying heartburn and regurgitation, and did not progress significantly. A stricture at the upper orifice of the esophagus was found (Figure A) and hampered the routine endoscopic examination (GIF-Q260; Olympus). Instead, an ultrathin endoscope (GIF-XP290N; Olympus) was used, which revealed a well demarcated translucent white scaly lesion with shaggy surface distributed in a two-thirds circumferential arrangement from 15 cm to 25 cm of the esophagus distal to the incisors (Figure B, Video A). Narrow-band imaging endoscopy showed a distinct white irregular map-like area (Figure C, Video A). Computer tomography (CT) did not show any neck mass or thickness of the cervical esophageal wall (Figure D). Multiple biopsies were obtained from the proximal esophagus. No malignancy was confirmed pathologically (Figure E).