J Gandhara Med Dent Sci

October - December 2026

ORIGINAL ARTICLE

How to cite this article

DIAGNOSTIC ACCURACY OF BARIUM SWALLOW S TUDY FOR DIFFERENTIATING BENIGN

AND MALIGNANT ESOPHAGEAL STRICTURES USING ENDOSCOPY WITH BIOPSY AS GOLD

STANDARD

Hira Syed

, Aman Nawaz Khan

, Ummara Siddique Umer

, Muhammad Hasnat

, Sara Khattak

, Maria Naz

Ashfaq Ahmad

ABSTRACT

OBJECTIVES

This study aimed to determine the diagnostic accuracy of barium swallow for

dierentiating malignant from benign oesophageal strictures using

endoscopy with biopsy as the reference standard.

METHODOLOGY

This cross-sectional validation study included 88 consecutively selected

adults with dysphagia at Rehman Medical Institute from 1 March 2023 to 1

August 2025. Barium swallow and endoscopic biopsy were performed within

two weeks. Malignancy was the positive condition. Diagnostic indices,

likelihood ratios, Cohen’s kappa and the area under the receiver operating

characteristic curve (AUC) were calculated with 95% condence intervals

(CIs).

RESULTS

Biopsy identied 26 malignant and 62 benign strictures. There were eight

true positives, 20 false positives, 18 false negatives and 42 true negatives.

Sensitivity was 30.8% (95% CI 14.3–51.8), specicity 67.7% (54.7–79.1),

positive predictive value 28.6% (13.2–48.7), negative predictive value 70.0%

(56.8–81.2) and accuracy 56.8% (45.8–67.3). Positive and negative

likelihood ratios were 0.95 (0.48–1.88) and 1.02 (0.75–1.39), respectively.

Kappa was −0.015 (−0.222 to 0.193), and binary-score AUC was 0.493

(0.385–0.600). Malignancy remained present in 18/60 benign-appearing

examinations (30.0%; 18.8–43.2).

CONCLUSION

Barium classication provided little discrimination and missed most biopsy-

conrmed malignancies. A benign-appearing examination should not be used

to exclude malignancy or defer indicated endoscopy with biopsy: the small

cohort and incomplete masking documentation limit generalisability.

KEYWORDS: Barium Sulfate; Esophageal Stenosis; Esophageal Neoplasms;

Deglutition Disorders; Sensitivity and Specicity

Syed H, Khan AN, Umer US, Hasnat

M, Khattak S, Naz M, et al.

Diagnostic Accuracy of Barium

Swallow Study for Differentiating

Benign And Malignant Esophageal

Strictures Using Endoscopy with

Biopsy as Gold Standard. J Gandhara

Med Dent Sci. 2026; 13(4): 14-19.

Date Submission: 05-02-2026

Date Revised: 05-09-2026

Date Acceptance: 05-09-2026

Head, Department of Radiology,

Correspondence

+92-333-9232968

drhirasyed33@gmail.com

INTRODUCTION

Oesophageal strictures cause dysphagia and create a

substantial diagnostic and healthcare burden.

Initial

assessment must distinguish benign narrowing from

malignancy rather than demonstrate luminal

obstruction. Contemporary European recommendations

identify upper gastrointestinal endoscopy as a central

investigation for adult oesophageal dysphagia, with

additional tests selected according to the structural or

functional question.

Barium oesophagography

provides information about oesophageal calibre,

contour and bolus transit, and has a complementary role

in evaluating obstructive symptoms.

Irregular

narrowing and shouldering may suggest malignancy,

whereas smooth, gradually tapering narrowing may

suggest a benign stricture. Evidence that barium detects

a narrowing must nevertheless be distinguished from

evidence that it reliably determines the cause of that

narrowing.

Endoscopic biopsy provides tissue for

aetiological classication; guidance on oesophageal

strictures recommends histological assessment to

exclude malignancy.

Dysphagia also warrants

endoscopic evaluation rather than reliance on an

assumed reux-related explanation.

The

clinically

relevant question is whether a benign barium

classification lowers cancer probability suciently to

reassure the clinician. This requires diagnostic-

performance and post-test probability estimates with

uncertainty, not an association test alone. This study

evaluated barium swallow as an adjunct for aetiological

classification in symptomatic adults, not as a population

screening test or a measure of anatomical imaging

utility. Its objective was to determine the diagnostic

accuracy of barium swallow for dierentiating benign

and malignant oesophageal strictures, using endoscopy

with biopsy as the reference standard.

Rehman Medical Institute, Peshawar

Professor, Department of Radiology,

Rehman Medical Institute, Peshawar

Hira Syed, Resident, Department of

Peshawar

Radiology, Rehman Medical Institute,

http://doi.org/10.37762/jgmds.13-4.862

J Gandhara Med Dent Sci

October - December 2026

METHODOLOGY

This cross-sectional validation study was conducted in

the Departments of Radiology and Gastroenterology,

Rehman Medical Institute, from 1 March 2023 to 1

August 2025 after obtaining approval from the

Institutional Review Board vide ref no: REC-PG-

RMI/Ethical Approval/PG-SYNOPSIS/109. Reporting

was revised using STARD 2015 and its explanation and

elaboration; incompletely documented items are

identified in the supplementary reporting map.

7,8

Consent forms were also obtained from the patients

prior to the conduct of the study. Eligibility comprised

age ≥18 years, either gender, dysphagia, and

completion of barium swallow followed by upper

gastrointestinal endoscopy with biopsy within two

weeks. Recruitment was described as non-probability

consecutive sampling. Patients with previous

oesophageal surgery, prior treatment for known

oesophageal malignancy, or incomplete or poor-quality

imaging or histopathology records were excluded. The

presenting symptom and participating departments are

documented, but the specic clinic, referral register and

screening workow used to identify every potentially

eligible patient are not. The analytical cohort comprised

88 participants with both test results. A screening log

was unavailable for this analysis, so the number

initially assessed, exclusions by reason and timing of

exclusions relative to enrolment could not be

reconstructed. Completion of both tests is therefore

established for the 88 analysed participants, not for

every initially eligible patient. Figure 1 distinguishes

the known paired-test pathway from unavailable

recruitment counts.

Adults with dysphagia in the participating departments

1 March 2023–1 August 2025

Number initially screened: unavailable.

↓

Original exclusions: previous oesophageal surgery; prior

treatment for known oesophageal

malignancy; incomplete/poor-

quality imaging or histopathology

Numbers excluded and timing before/after enrolment:

unavailable

↓

Paired-test cohort represented in the available data: n = 88

Both barium swallow and endoscopic biopsy recorded

↓

Barium

malignant

n = 28

Barium benign

n = 60

↓

Endoscopy with biopsy

Malignant: 8 (TP)

Benign: 20 (FP)

All 28 analysed

Endoscopy with biopsy

Malignant: 18 (FN)

Benign: 42 (TN)

All 60 analysed

↓

Final reanalysis: n = 88

Missing paired results: 0; additional reanalysis exclusions: 0

Figure 1: Participant Flow B

ased on the

Available Study Records.

The original account attributed planning to a WHO

sample-size calculator and recorded a target of 80

participants plus eight additional participants for

incomplete data, giving 88. Assumptions were

sensitivity 100%, specicity 94.4%, malignancy

prevalence 30%, 95% condence and 10% absolute

precision. The calculator module/output and a veriable

source for the paired performance assumptions were

unavailable. These inputs do not reproduce the stated

requirements of 80 for sensitivity and 49 for specicity

using standard prevalence-adjusted precision formulas.

Sensitivity of 100% gives a degenerate normal-

approximation variance, while the specicity

calculation gives 29.01, rounded up to 30, rather than

49. Accordingly, 88 is reported as the achieved cohort

without claiming that the intended precision was

established. The supplementary audit shows the

calculations; no replacement post hoc planning

assumptions were introduced. Barium swallow

examinations were performed under uoroscopic

guidance using the departmental protocol. Stricture

location, length and morphology were assessed. The

study description specied predened qualitative

criteria: irregular margins, mucosal irregularity, abrupt

tapering and shouldering suggested malignancy,

whereas smooth, symmetric and gradually tapering

narrowing suggested a benign stricture. A formal

feature-combination rule, structured reporting template,

contrast protocol and equipment details were not

available for verication. Analysis used the recorded

binary classication without reinterpreting images or

changing its threshold. An experienced

gastroenterologist performed upper gastrointestinal

endoscopy, and multiple biopsies were obtained from

the stricture. A consultant pathologist classied

specimens as benign or malignant and was blinded to

imaging ndings. Histopathological malignancy was

the positive reference condition because the question

concerned tissue-conrmed aetiology rather than

appearance alone.

Detailed specimen numbers and

processing, histological subtypes, and repeat sampling

or follow-up conrmation of initially benign biopsies

were unavailable. Radiologist masking to clinical,

endoscopic and histopathological information was not

documented. Information available to the endoscopist,

the number and experience of radiologists, and

independent or consensus reading procedures were also

unspecied. One nal barium classication per patient

was retained in the data; this does not establish that

only one reader interpreted each examination. Reader-

specific and repeat-reading results were unavailable,

precluding interobserver and intraobserver

reproducibility analyses. The stated interval between

examinations was no more than two weeks. Individual

test dates and treatment between examinations were not

Diagnostic Accuracy of Barium Swallow Study for Dierenti ating

J Gandhara Med Dent Sci

October - December 2026

recorded in the analytical dataset. Test-related adverse-

event data were unavailable. The original descriptive

and crosstab outputs were generated in IBM SPSS

Statistics version 23.0, as identied in the output

metadata. Supplementary diagnostic calculations were

independently reproduced in Python with SciPy. The

SPSS and Excel les were compared row by row. Age

was summarised as mean  standard deviation and

range, and categorical variables as numbers and

percentages. There were no missing values in age,

gender or either diagnostic classication among the 88

records. No indeterminate category was recorded, and

no imputation or reassignment was performed.

Malignant barium ndings were index-test positive and

benign ndings negative. The 2  2 table was used to

calculate sensitivity, specicity, positive predictive

value (PPV), negative predictive value (NPV),

accuracy, false-negative rate and malignancy

probability after a benign barium result. Two-sided

95% ClopperPearson exact binomial CIs were

calculated for proportions.

Positive and negative

likelihood ratios (LR+ and LR−) and the diagnostic

odds ratio (DOR) were reported with log-scale Wald

95% CIs; no zero-cell correction was required.

Between-test agreement was quantied using

unweighted Cohen‘s kappa, with an asymptotic

multinomial-variance 95% CI.

This assesses

agreement between diagnostic classications, not

reader reproducibility. AUC was calculated from the

binary index score (malignant = 1; benign = 0), with

ties given half credit and a DeLong nonparametric

variance-based 95% CI.

Only one nontrivial ROC

operating point was available; binary AUC equalled the

average of sensitivity and specicity. No continuous -

score ROC curve, threshold optimisation or test-label

reorientation was undertaken. The original Pearson chi-

square association results were reproduced for the

supplementary audit, but not used to judge diagnostic

usefulness or agreement. Gender analyses were

presented as descriptive diagnostic estimates with exact

CIs. Exploratory age analysis used a <60/≥60-year

division introduced during revision, not a prespecied

or validated clinical cut-o. No subgroup hypothesis

tests or interaction claims were made. Lesion location,

stricture length and histological subtype analyses were

not possible because these variables were absent from

the patient-level les.

RESULTS

All 88 available records were included. Mean age was

53.74  14.42 years (range 3179); 55 participants were

male and 33 female (Table I). Histopathology identied

malignancy in 26/88 participants (29.5%; 95% CI 20.3

40.2). No additional records were excluded during

reanalysis. This complete-case count does not resolve

unavailable pre-analysis screening and exclusion totals

(Figure 1). The paired classications yielded eight true

positives, 20 false positives, 18 false negatives and 42

true negatives (Table 2). The false-negative rate among

biopsy-confirmed malignancies was 69.2% (18/26; 95%

CI 48.285.7). Among benign barium classications,

18/60 were malignant on biopsy (30.0%; 95% CI 18.8

43.2). These percentages have dierent denominators

and address dierent diagnostic questions. Table 3

reports the principal estimates with 95% CIs.

Sensitivity was 30.8%, specicity 67.7% and accuracy

56.8%. LR+ was 0.95, LR− 1.02 and DOR 0.93.

Observed agreement was 50/88 (56.8%), compared

with 57.4% expected agreement from the marginal

totals, giving kappa −0.015. Binary-score AUC was

0.493. Exploratory age and gender estimates, subgroup

counts and exact CIs appear in Supplementary Tables

SISII. Gender-specific NPVs were 75.6% in males

(34/45; 95% CI 60.587.1) and 53.3% in females (8/15;

95% CI 26.678.7), with barium-negative participants

as the denominator. Subgroup sensitivity estimates

were imprecise, particularly with only eight

malignancies in participants aged ≥60 years. Lesion-

specific or histological determinants could not be

analysed.

Table 1: Characteristics and Diagnostic Classications (n = 88)

Characteristic Value

Age (years), mean  SD 53.74  14.42

Age (years), range 3179

Gender: male 55 (62.5%)

Gender: female 33 (37.5%)

Barium: malignant 28 (31.8%)

Barium: benign 60 (68.2%)

Biopsy: malignant 26 (29.5%)

Biopsy: benign 62 (70.5%)

Table 2: Transvaginal Ultrasonography and Histopathological

Findings (n = 93)

Barium

Classification

Biopsy Total

Malignant

(positive)

Benign

(negative)

Malignant (positive) 8 (TP) 20 (FP) 28

Benign (negative) 18 (FN) 42 (TN) 60

Total 26 62 88

TP: true positive; FP: false positive; FN: false negative; TN:

true negative. Malignancy is the positive Condition for both tests.

Diagnostic Accuracy of Barium Swallow Study for Dierenti ating

J Gandhara Med Dent Sci

October - December 2026

Table 3: Diagnostic Performance and Between-Test Agreement

(n= 88)

Measure Calculation

Estimate (95%CI

Sensitivity (%) 8/26 30.8 (14.351.8)

Specificity (%) 42/62 67.7 (54.779.1)

Positive predictive value (%) 8/28 28.6 (13.248.7)

Negative predictive value (%) 42/60 70.0 (56.881.2)

Overall accuracy (%) 50/88 56.8 (45.867.3)

False-negative rate (%) 18/26 69.2 (48.285.7)

Malignancy after benign

barium (%)

18/60 30.0 (18.843.2)

Positive likelihood ratio Se / (1 − Sp) 0.95 (0.481.88)

Negative likelihood ratio (1 − Se) / Sp 1.02 (0.751.39)

Diagnostic odds ratio LR+ / LR− 0.93 (0.352.51)

Cohen’s kappa Unweighted −0.015 (−0.222 to

0.193)

Binary-score AUC (Se + Sp) / 2 0.493 (0.3850.600)

DISCUSSION

Barium classication did not meaningfully separate

malignant from benign strictures in this cohort. The

central nding was not the non-significant association

test, but failure to identify 18 of 26 biopsy-confirmed

malignancies. Sensitivity and accuracy were clinically

unsatisfactory for an exclusion strategy; describing

specificity alone as -moderate ǁ would obscure this

limitation. LR+ and LR− were approximately one,

while kappa and AUC point estimates were close to

values indicating little agreement beyond chance and

little discrimination. Their CIs remain important: these

data neither establish exact equivalence to chance

performance nor exclude all potentially useful

performance in other settings. The observed

malignancy probability was 29.5% before considering

the barium result and 30.0% after a benign

classification. NPV of 70.0% should not be interpreted

apart from the prevalence or the 18 cancers among 60

benign-appearing examinations. Using such a result to

defer indicated biopsy could delay diagnosis, although

diagnostic delays, tumour stage and patient outcomes

were not measured. The supported implication is to

avoid treating benign radiological appearance as

evidence that cancer has been excluded. The contrast

with earlier evidence requires attention to design. Gupta

et al. classied 100 examinations as benign (75),

malignant (11) or equivocal (14); none of the 75 benign

classifications had carcinoma on endoscopy, whereas

one carcinoma occurred in the equivocal group.

Brushings or biopsy were performed in only 57

patients. Their three-category classication and mixed

endoscopic/pathological verication dier from the

binary classications and biopsy results available for

every analysed participant here.

In a series of 50

confirmed cancers, Levine et al. reported radiographic

diagnosis or suspicion of carcinoma in 48 cases (96%).

That cancer-enriched sensitivity series is not directly

comparable with this mixed stricture cohort.

Possible

explanations include dierences in examination

technique, luminal distension, lesion morphology,

reader expertise and the threshold for a malignant label.

These are hypotheses, not demonstrated explanations:

the les lacked the necessary technical and lesion-level

information. Qualitative descriptors alone also do not

establish application of a reproducible standardised

scoring rule. The study cannot determine whether poor

performance arose from the imaging method, local

implementation, referral spectrum or a combination of

factors. Selection and verication require separate

consideration. Diagnostic estimates may change with

patient spectrum, reference-standard application and

readers‘ access to other test results.

15,16

Every analysed

participant had the same type of reference examination,

limiting dierential verication within this cohort.

Nevertheless, restricting analysis to complete paired

investigations without a screening log leaves open

whether unveried or technically dicult cases were

excluded beforehand. Consecutive sampling does not

eliminate this uncertainty or referral-related selection in

a single-centre cohort. Pathologist blinding is a

strength, but radiologist masking remains unknown

rather than demonstrably present or absent. Endoscopic

biopsy is an operational reference standard, not

infallible adjudication of every stricture. Cao et al.

described selected smooth malignant strictures despite

negative conventional biopsies, with diagnosis

established by ultrasound-guided sampling.

Min et al.

likewise studied ultrasound-guided sampling in

suspicious, often biopsy-negative strictures.

These

reports do not estimate the false-negative biopsy rate in

the present patients, but explain why persistent clinical

suspicion cannot automatically be dismissed after a

negative mucosal biopsy. Without repeat sampling or

follow-up, reference-standard misclassication cannot

be excluded; these estimates are relative to recorded

biopsy classications. Current dysphagia guidance

CIs: exact ClopperPearson for proportions; log-scale

Wald for ratios; asymptotic multinomial for kappa;

DeLong variance-based for AUC. The binary AUC

has one nontrivial ROC point and is not a continuous-

score threshold analysis.

CI: condence interval; Se: sensitivity; Sp:

specificity; LR+: positive likelihood ratio; LR−:

negative likelihood ratio; AUC: area under the

receiver operating characteristic curve. Se and Sp are

proportions in the ratio/AUC formulas.

Diagnostic Accuracy of Barium Swallow Study for Dierenti ating

J Gandhara Med Dent Sci

ORIGINAL ARTICLE

October - December 2026

places barium examinations alongside, rather than in

place of, endoscopic and other targeted

investigations.

2,3

The results argue against using binary

barium classication as a stand-alone malignancy rule-

out test in a comparable symptomatic population. They

do not negate anatomical or functional benets that

were not measured, and should not be extrapolated to

screening populations or centres using dierent

acquisition and interpretation protocols.

LIMITATIONS

The study was small, single-centre and non-

probabilistic, with only 26 malignant cases and wide

CIs. Screening totals, exclusion timing, data-collection

timing relative to testing, radiologist masking and

acquisition/reporting details were incompletely

documented. Disease stage, benign aetiologies, lesion

site and length, histological subtype, individual test

intervals, intervening treatment, adverse events and

follow-up were unavailable. Interobserver and

intraobserver reproducibility could not be assessed;

between-test kappa does not replace these analyses.

Exploratory subgroups do not establish age or gender

dierences. These limitations restrict precision,

reproducibility and generalisability and prevent

attribution of low sensitivity to a specic mechanism.

CONCLUSIONS

In adults with dysphagia and oesophageal strictures,

barium swallow showed low sensitivity, poor overall

accuracy and likelihood ratios close to one for

malignant classication. A benign-appearing

examination did not exclude malignancy and should not

defer clinically indicated endoscopy with biopsy. These

findings require interpretation alongside the sampling,

documentation and precision limitations.

CONFLICT OF INTEREST: None

FUNDING SOURCES: None

REFERENCES

1. Xue AZ, Anderson C, Cotton CC, Gaber CE, Feltner C, Dellon

ES. Prevalence and costs of esophageal strictures in the United

States. Clin Gastroenterol Hepatol. 2024;22(9):1821-1829.e4.

doi:10.1016/j.cgh.2024.03.026. PMID: 38588766.

2. Mari A, Calabrese F, Pasta A, Lorenzon G, Weusten B, Keller J,

et al. Esophageal and oropharyngeal dysphagia: clinical

recommendations from the United European Gastroenterology

and European Society for Neurogastroenterology and Motility.

United European Gastroenterol J. 2025;13(6):855-901.

doi:10.1002/ueg2.70062. PMID: 40543044.

3. Gyawali CP, Carlson DA, Chen JW, Patel A, Wong RJ,

Yadlapati RH. ACG clinical guidelines: clinical use of

esophageal physiologic testing. Am J Gastroenterol.

2020;115(9):1412-1428. doi:10.14309/ajg.0000000000000734.

PMID: 32769426.

4. Gupta S, Levine MS, Rubesin SE, Katzka DA, Laufer I.

Usefulness of barium studies for dierentiating benign and

malignant strictures of the esophagus. AJR Am J Roentgenol.

2003;180(3):737-744. doi:10.2214/ajr.180.3.1800737. PMID:

12591686.

5. Sami SS, Haboubi HN, Ang Y, Boger P, Bhandari P, de

Caestecker J, et al. UK guidelines on oesophageal dilatation in

clinical practice. Gut. 2018;67(6):1000-1023.

doi:10.1136/gutjnl-2017-315414. PMID: 29478034.

6. Katz PO, Dunbar KB, Schnoll-Sussman FH, Greer KB,

Yadlapati R, Spechler SJ. ACG clinical guideline for the

diagnosis and management of gastroesophageal reux disease.

Am J Gastroenterol. 2022;117(1):27-56.

doi:10.14309/ajg.0000000000001538. PMID: 34807007.

7. Bossuyt PM, Reitsma JB, Bruns DE, Gatsonis CA, Glasziou PP,

Irwig L, et al. STARD 2015: an updated list of essential items

for reporting diagnostic accuracy studies. BMJ. 2015;351.

doi:10.1136/bmj.h5527. PMID: 26511519.

8. Cohen JF, Korevaar DA, Altman DG, Bruns DE, Gatsonis CA,

Hooft L, et al. STARD 2015 guidelines for reporting diagnostic

accuracy studies: explanation and elaboration. BMJ Open.

2016;6(11). doi:10.1136/bmjopen-2016-012799. PMID:

28137831.

9. Buderer NM. Statistical methodology: I. Incorporating the

prevalence of disease into the sample size calculation for

sensitivity and specicity. Acad Emerg Med. 1996;3(9):895-

900. doi:10.1111/j.1553-2712.1996.tb03538.x. PMID: 8870764.

10. Clopper CJ, Pearson ES. The use of condence or ducial

limits illustrated in the case of the binomial. Biometrika.

1934;26(4):404-413. doi:10.1093/biomet/26.4.404. PMID: not

available.

11. Simel DL, Samsa GP, Matchar DB. Likelihood ratios with

condence: sample size estimation for diagnostic test studies. J

Clin Epidemiol. 1991;44(8):763-770. doi:10.1016/0895-

4356(91)90128-V . PMID: 1941027.

12. Fleiss JL, Cohen J, Everitt BS. Large sample standard errors of

kappa and weighted kappa. Psychol Bull. 1969;72(5):323-327.

doi:10.1037/h0028106. PMID: not available.

13. DeLong ER, DeLong DM, Clarke-Pearson DL. Comparing the

areas under two or more correlated receiver operating

characteristic curves: a nonparametric approach. Biometrics.

1988;44(3):837-845. doi:10.2307/2531595. PMID: 3203132.

14. Levine MS, Chu P, Furth EE, Rubesin SE, Laufer I, Herlinger

H. Carcinoma of the esophagus and esophagogastric junction:

sensitivity of radiographic diagnosis. AJR Am J Roentgenol.

1997;168(6):1423-1426. doi:10.2214/ajr.168.6.9168701. PMID:

9168701.

15. Lijmer JG, Mol BW, Heisterkamp S, Bonsel GJ, Prins MH, van

der Meulen JH, et al. Empirical evidence of design-related bias

in studies of diagnostic tests. JAMA. 1999;282(11):1061-1066.

doi:10.1001/jama.282.11.1061. PMID: 10493205.

16. Whiting PF, Rutjes AWS, Westwood ME, Mallett S, Deeks JJ,

Reitsma JB, et al. QUADAS-2: a revised tool for the quality

assessment of diagnostic accuracy studies. Ann Intern Med.

2011;155(8):529-536. doi:10.7326/0003-4819-155-8-

201110180-00009. PMID: 22007046.

17. Cao F, Chen G, Su W, Zhang Z, Fu Q, Zhou D, et al.

Endoscopic ultrasound-guided fine needle aspiration for smooth

benign appearing malignant esophageal stricture: a cross-

sectional study. J Thorac Dis. 2022;14(6):2112-2121.

doi:10.21037/jtd-22-584. PMID: 35813754.

Diagnostic Accuracy of Barium Swallow Study for Dierenti ating

J Gandhara Med Dent Sci

October - December 2026

18. Min L, Qing Y, Chu Y, Liang C, Lv L, Liu D, et al. Role of

endoscopic ultrasound-guided ne needle aspiration (EUS-

FNA) in the diagnosis of suspicious malignant esophageal

strictures. J Clin Med. 2023;12(6):2153.

doi:10.3390/jcm12062153. PMID: 36983155.

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Hira Syed

Concept & Design; Data Acquisition; Data

Analysis/Interpretation; Drafting Manuscript; Critical

Revision; Supervision; Final Approval

Aman Nawaz Khan

Concept & Design; Data Acquisition;

Data Analysis/Interpretation; Drafting Manuscript;

Critical

Revision; Supervision; Final

Approval

Ummara Siddique Umer

Concept & Design; Data

Acquisition; Data Analysis/Interpretation; Drafting

Manuscript; Critical Revision; Supervision; Final Approval

Muhammad Hasnat

Concept & Design; Data Acquisition;

Data Analysis/Interpretation; Drafting Manuscript; Critical

Revision; Final Approval

Sara Khattak

Concept & Design; Data Acquisition; Data

Analysis/Interpretation; Drafting Manuscript; Critical

Revision; Final Approval

Maria Naz

Concept & Design; Data Acquisition; Data

Analysis/Interpretation; Drafting Manuscript; Critical

Revision; Final Approval

Ashfaq Ahmad

Concept & Design; Data Acquisition; Data

Analysis/Interpretation; Drafting Manuscript; Critical

Revision; Final Approval

AUTHORS CONTRIBUTION

The authors accept responsibility for all aspects of the work

and will ensure that any concerns regarding the accuracy or

integrity of any part are properly investigated and resolved.

Diagnostic Accuracy of Barium Swallow Study for Dierenti ating