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Management of benign esophageal strictures

Moises Guelrud, MD
Section Editor
John R Saltzman, MD, FACP, FACG, FASGE, AGAF
Deputy Editor
Anne C Travis, MD, MSc, FACG, AGAF


The majority of benign esophageal strictures result from long-standing gastroesophageal reflux [1,2]. Treatment usually involves dilation combined with acid-suppressive therapy. (See "Complications of gastroesophageal reflux in adults".)

Approximately 25 percent of cases of benign esophageal strictures are unrelated to gastroesophageal reflux, and treatment in these cases may be more difficult. Examples include strictures secondary to external beam radiation, esophageal sclerotherapy, caustic ingestions (see "Caustic esophageal injury in adults"), surgical anastomosis, and rare dermatologic diseases (eg, epidermolysis bullosa dystrophica). Strictures may also result from external compression of the esophagus due to mediastinal fibrosis induced by tuberculosis or idiopathic fibrosing mediastinitis. These conditions result in long and narrow strictures that are difficult to dilate, and in which dilation may be associated with a higher rate of complications. Eosinophilic esophagitis is a more commonly recognized cause of esophageal strictures, particularly in young men. Its recognition is important since dilation can be associated with mucosal tearing and perforation. (See "Clinical manifestations and diagnosis of eosinophilic esophagitis".)

The goals of therapy for benign esophageal strictures are the relief of dysphagia and the prevention of stricture recurrence [3]. In the majority of patients, this can be accomplished with esophageal dilation, though in cases of refractory strictures, additional therapy may be required.

This topic will review the management of benign esophageal strictures, including patient selection, methods of dilation, and treatment of refractory esophageal strictures. Complications of dilation, pneumatic dilation of the lower esophageal sphincter for achalasia, dilation of esophageal rings and webs, and management of malignant esophageal obstruction are discussed separately. (See "Complications of endoscopic esophageal stricture dilation" and "Pneumatic dilation and botulinum toxin injection for achalasia", section on 'Pneumatic dilation' and "Esophageal rings and webs", section on 'Treatment' and "Use of expandable stents in the esophagus" and "Endoscopic palliation of esophageal cancer".)


The cardinal feature of an esophageal stricture is dysphagia. However, dysphagia may be caused by conditions other than an esophageal stricture, such as gastroesophageal reflux disease, motility disturbances, infection, malignancy, and esophageal webs or rings. Although treatment of some of these conditions may involve esophageal dilation, the specific techniques used differ. Therefore, endoscopic and/or radiographic evaluation of the stricture is required prior to determining a course of therapy. (See "Overview of dysphagia in adults".)


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Literature review current through: Sep 2016. | This topic last updated: Feb 8, 2016.
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