Benign strictures of the esophagus and gastric outlet: interventional management

Abstract

Benign strictures of the esophagus and gastric outlet are difficult to manage conservatively and they usually require intervention to relieve dysphagia or to treat the stricture-related complications. In this article, authors review the non-surgical options that are used to treat benign strictures of the esophagus and gastric outlet, including balloon dilation, temporary stent placement, intralesional steroid injection and incisional therapy.

Keywords: Benign esophageal strictures; Benign gastric-outlet strictures; Endoscopy; Fluoroscopy; Interventional procedure.

Fig. 1

Radiation-induced esophageal stricture. A. Esophagogram shows 5-cm long stricture (arrow) in mid-esophageal area. B. Dilation of stricture using 15-mm-diameter balloon under fluoroscopic guidance. Because dilation was not easily accomplished, caliber of balloon catheter was not increased to 20 mm. C. Esophagogram one month after balloon dilation shows improvement of stricture (arrow). Patient's symptoms were also resolved, but symptoms recurred two months later.

Fig. 2

Corrosive esophageal stricture. A. Esophagogram shows focal stricture (arrow) at distal esophageal level. B. Severe tight stricture precluded dilation with 10-mm-diameter balloon. C. Placement of retrievable covered metallic stent (arrowheads) at stricture. D. Esophagogram immediately after stent placement shows good contrast passage through stent. E. Esophagogram five years after temporary stenting for two months shows stricture improvement was maintained (arrow).

Fig. 3

Peptic ulcer-induced duodenal stricture. A. Upper gastrointestinal series shows peptic ulcer-induced stricture (arrow) in second portion of duodenum. B-E. Under fluoroscopic guidance, stricture was initially dilated with 8-mm-diameter balloon. Because dilation was easily achieved, caliber of balloon catheter was increased to 15 mm. F. Upper gastrointestinal series one year after balloon dilation shows improvement of luminal diameter (arrow).

Fig. 4

Benign anastomotic stricture at gastroduodenostomy. A, B. Endoscopic image (arrowhead) and upper gastrointestinal series (arrow) show severe anastomotic stricture upon gastroduodenostomy. C. Because stricture was resistant to repeated balloon dilation, retrievable covered metallic stent (arrow) was inserted. D, E. Three months after stent placement, stent was endoscopically removed using rat-tooth forceps (arrowhead). Endoscopic image immediately after stent removal showed improvement of stricture (arrowheads).