Endoscopic management of benign recalcitrant esophageal strictures

Abstract

Benign esophageal strictures are one of the common clinical conditions managed by endoscopists. Nearly 90% of the benign esophageal strictures respond to endoscopic dilation. However, a small percentage of patients progress to recalcitrant strictures. The benign recalcitrant esophageal strictures are difficult to manage both medically and endoscopically as they do not respond to conventional treatment with proton pump inhibitors and esophageal dilations. Patients with benign recalcitrant esophageal strictures are at a high risk of developing debilitating malnutrition and morbidity due to severe dysphagia. This condition is associated with psychological trauma to patients as treatments are usually prolonged with poor outcomes. Also, this can be a financial burden on the healthcare industry due to several sessions of treatment. In this article, we discuss the classification of benign esophageal strictures, evidence-based treatment strategies, endoscopic procedural techniques, and complications of endoscopic interventions. We aim to guide providers in managing benign esophageal strictures with a focus on endoscopic management of benign recalcitrant esophageal strictures.

Keywords: Benign recalcitrant esophageal strictures; IT knife; esophageal stent; intralesional steroid injection; mitomycin C.

Figure 1

Benign recalcitrant esophageal stricture

Figure 2

Balloon dilation of a benign recalcitrant esophageal stricture (A) Pre-dilation, (B) Balloon dilation, and (C) Post-dilation mucosal tear

Figure 3

Benign recalcitrant esophageal stricture before (A) and after (B) standard needle knife stricturoplasty

Figure 4

Pre-treatment (A) and post-treatment (B) appearance of the benign recalcitrant esophageal stricture with IT knife stricturoplasty

Figure 5

Benign recalcitrant esophageal stricture (A) after self-expanding metal stent placement and (B) after stent removal

Figure 6

Algorithm for management of benign esophageal strictures LAMS, lumen apposing metal stent