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Management of benign esophageal strictures

INTRODUCTION

The goals of therapy for benign esophageal strictures are the relief of dysphagia and the prevention of stricture recurrence [1]. Patient selection, methods of dilation, and treatment of refractory esophageal strictures will be reviewed here. Complications of dilation are discussed separately. (See "Complications of esophageal stricture dilation".) Dilation of the lower esophageal sphincter for achalasia and dilation of esophageal rings and webs are also reviewed elsewhere. (See "Overview of the treatment of achalasia" and "Esophageal webs and rings".)

ETIOLOGY

The majority of benign strictures that are found in the esophagus result from long-standing gastroesophageal reflux [2,3]. 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 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 an emerging 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".)

EVALUATION PRIOR TO DILATION

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. (See appropriate topic reviews.) Although treatment of some of these conditions may involve esophageal dilation, the specific technique used differs among them, requiring accurate diagnosis and planning of the appropriate treatment strategy prior to embarking upon dilation.

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Last literature review version 18.2: May 2010
This topic last updated: January 29, 2009
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Management of benign esophageal strictures