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. 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
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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 roentgen anatomic correlation. Observations on the pharyngoesophagus. Am J Roentgenol Radium Ther Nucl Med. 121(2):221-31, 1974