Official reprint from UpToDate®
www.uptodate.com ©2017 UpToDate, Inc. and/or its affiliates. All Rights Reserved.

Complications of endoscopic esophageal stricture dilation

Moises Guelrud, MD
Section Editor
John R Saltzman, MD, FACP, FACG, FASGE, AGAF
Deputy Editor
Kristen M Robson, MD, MBA, FACG


The treatment of benign esophageal strictures typically involves dilation combined with acid suppressive therapy. Advances in endoscopic equipment and dilators have improved the safety of esophageal dilation [1], but esophageal dilation may lead to complications even in the most experienced hands. Awareness of the complications associated with dilation permits early recognition and reduces morbidity and mortality.

This topic will review the major complications associated with esophageal stricture dilation. The techniques used for the dilation of benign esophageal strictures, the approach to patients with non-iatrogenic esophageal perforations, and the complications associated with upper endoscopy in general are discussed separately.

(See "Management of benign esophageal strictures".)

(See "Boerhaave syndrome: Effort rupture of the esophagus".)

(See "Overview of esophageal perforation due to blunt or penetrating trauma".)

To continue reading this article, you must log in with your personal, hospital, or group practice subscription. For more information on subscription options, click below on the option that best describes you:

Subscribers log in here

Literature review current through: Nov 2017. | This topic last updated: Oct 09, 2017.
The content on the UpToDate website is not intended nor recommended as a substitute for medical advice, diagnosis, or treatment. Always seek the advice of your own physician or other qualified health care professional regarding any medical questions or conditions. The use of this website is governed by the UpToDate Terms of Use ©2017 UpToDate, Inc.
  1. Standards of Practice Committee, Egan JV, Baron TH, et al. Esophageal dilation. Gastrointest Endosc 2006; 63:755.
  2. Brinster CJ, Singhal S, Lee L, et al. Evolving options in the management of esophageal perforation. Ann Thorac Surg 2004; 77:1475.
  3. Mandelstam P, Sugawa C, Silvis SE, et al. Complications associated with esophagogastroduodenoscopy and with esophageal dilation. Gastrointest Endosc 1976; 23:16.
  4. Pereira-Lima JC, Ramires RP, Zamin I Jr, et al. Endoscopic dilation of benign esophageal strictures: report on 1043 procedures. Am J Gastroenterol 1999; 94:1497.
  5. Hernandez LV, Jacobson JW, Harris MS. Comparison among the perforation rates of Maloney, balloon, and savary dilation of esophageal strictures. Gastrointest Endosc 2000; 51:460.
  6. Piotet E, Escher A, Monnier P. Esophageal and pharyngeal strictures: report on 1,862 endoscopic dilatations using the Savary-Gilliard technique. Eur Arch Otorhinolaryngol 2008; 265:357.
  7. Karnak I, Tanyel FC, Büyükpamukçu N, Hiçsönmez A. Esophageal perforations encountered during the dilation of caustic esophageal strictures. J Cardiovasc Surg (Torino) 1998; 39:373.
  8. Silvis SE, Nebel O, Rogers G, et al. Endoscopic complications. Results of the 1974 American Society for Gastrointestinal Endoscopy Survey. JAMA 1976; 235:928.
  9. Nostrant TT, Nandi PS. Esophageal dilation. Gastroenterologist 1998; 6:5.
  10. Marshall JB, Afridi SA, King PD, et al. Esophageal dilation with polyvinyl (American) dilators over a marked guidewire: practice and safety at one center over a 5-yr period. Am J Gastroenterol 1996; 91:1503.
  11. Tucker LE. Esophageal stricture: results of dilation of 300 patients. Mo Med 1992; 89:668.
  12. Swaroop VS, Desai DC, Mohandas KM, et al. Dilation of esophageal strictures induced by radiation therapy for cancer of the esophagus. Gastrointest Endosc 1994; 40:311.
  13. Kaplan M, Mutlu EA, Jakate S, et al. Endoscopy in eosinophilic esophagitis: "feline" esophagus and perforation risk. Clin Gastroenterol Hepatol 2003; 1:433.
  14. Jung KW, Gundersen N, Kopacova J, et al. Occurrence of and risk factors for complications after endoscopic dilation in eosinophilic esophagitis. Gastrointest Endosc 2011; 73:15.
  15. Cohen MS, Kaufman AB, Palazzo JP, et al. An audit of endoscopic complications in adult eosinophilic esophagitis. Clin Gastroenterol Hepatol 2007; 5:1149.
  16. Eisenbach C, Merle U, Schirmacher P, et al. Perforation of the esophagus after dilation treatment for dysphagia in a patient with eosinophilic esophagitis. Endoscopy 2006; 38 Suppl 2:E43.
  17. Dougherty M, Runge TM, Eluri S, Dellon ES. Esophageal dilation with either bougie or balloon technique as a treatment for eosinophilic esophagitis: a systematic review and meta-analysis. Gastrointest Endosc 2017; 86:581.
  18. Jacobs JW Jr, Spechler SJ. A systematic review of the risk of perforation during esophageal dilation for patients with eosinophilic esophagitis. Dig Dis Sci 2010; 55:1512.
  19. Kavic SM, Basson MD. Complications of endoscopy. Am J Surg 2001; 181:319.
  20. Søreide JA, Viste A. Esophageal perforation: diagnostic work-up and clinical decision-making in the first 24 hours. Scand J Trauma Resusc Emerg Med 2011; 19:66.
  21. Attar S, Hankins JR, Suter CM, et al. Esophageal perforation: a therapeutic challenge. Ann Thorac Surg 1990; 50:45.
  22. Maher MM, Lucey BC, Boland G, et al. The role of interventional radiology in the treatment of mediastinal collections caused by esophageal anastomotic leaks. AJR Am J Roentgenol 2002; 178:649.
  23. Holm AN, de la Mora Levy JG, Gostout CJ, et al. Self-expanding plastic stents in treatment of benign esophageal conditions. Gastrointest Endosc 2008; 67:20.
  24. Dua KS, Vleggaar FP, Santharam R, Siersema PD. Removable self-expanding plastic esophageal stent as a continuous, non-permanent dilator in treating refractory benign esophageal strictures: a prospective two-center study. Am J Gastroenterol 2008; 103:2988.
  25. Kim JH, Song HY, Choi EK, et al. Temporary metallic stent placement in the treatment of refractory benign esophageal strictures: results and factors associated with outcome in 55 patients. Eur Radiol 2009; 19:384.
  26. White RK, Morris DM. Diagnosis and management of esophageal perforations. Am Surg 1992; 58:112.
  27. Reeder LB, DeFilippi VJ, Ferguson MK. Current results of therapy for esophageal perforation. Am J Surg 1995; 169:615.
  28. Sawyer R, Phillips C, Vakil N. Short- and long-term outcome of esophageal perforation. Gastrointest Endosc 1995; 41:130.
  29. Sarr MG, Pemberton JH, Payne WS. Management of instrumental perforations of the esophagus. J Thorac Cardiovasc Surg 1982; 84:211.
  30. Han SY, McElvein RB, Aldrete JS, Tishler JM. Perforation of the esophagus: correlation of site and cause with plain film findings. AJR Am J Roentgenol 1985; 145:537.
  31. Peter P Lopez. Complications of esophageal surgery and trauma. In: Complications in srugery and trauma, Stephen M. Cohn (Ed), Informa Healthcare USA, Inc., New York 2007. p.257.
  32. Foley MJ, Ghahremani GG, Rogers LF. Reappraisal of contrast media used to detect upper gastrointestinal perforations: comparison of ionic water-soluble media with barium sulfate. Radiology 1982; 144:231.
  33. Bladergroen MR, Lowe JE, Postlethwait RW. Diagnosis and recommended management of esophageal perforation and rupture. Ann Thorac Surg 1986; 42:235.
  34. Dodds WJ, Stewart ET, Vlymen WJ. Appropriate contrast media for evaluation of esophageal disruption. Radiology 1982; 144:439.
  35. White CS, Templeton PA, Attar S. Esophageal perforation: CT findings. AJR Am J Roentgenol 1993; 160:767.
  36. Madanick RD. Medical management of iatrogenic esophageal perforations. Curr Treat Options Gastroenterol 2008; 11:54.
  37. Shaffer HA Jr, Valenzuela G, Mittal RK. Esophageal perforation. A reassessment of the criteria for choosing medical or surgical therapy. Arch Intern Med 1992; 152:757.
  38. Mengoli LR, Klassen KP. Conservative management of esophageal perforation. Arch Surg 1965; 91:238.
  39. Lyons WS, Seremetis MG, deGuzman VC, Peabody JW Jr. Ruptures and perforations of the esophagus: the case for conservative supportive management. Ann Thorac Surg 1978; 25:346.
  40. Cameron JL, Kieffer RF, Hendrix TR, et al. Selective nonoperative management of contained intrathoracic esophageal disruptions. Ann Thorac Surg 1979; 27:404.
  41. Altorjay A, Kiss J, Vörös A, Bohák A. Nonoperative management of esophageal perforations. Is it justified? Ann Surg 1997; 225:415.
  42. Martinez L, Rivas S, Hernández F, et al. Aggressive conservative treatment of esophageal perforations in children. J Pediatr Surg 2003; 38:685.
  43. Vogel SB, Rout WR, Martin TD, Abbitt PL. Esophageal perforation in adults: aggressive, conservative treatment lowers morbidity and mortality. Ann Surg 2005; 241:1016.
  44. Hasan S, Jilaihawi AN, Prakash D. Conservative management of iatrogenic oesophageal perforations--a viable option. Eur J Cardiothorac Surg 2005; 28:7.
  45. Thornblade LW, Cheng AM, Wood DE, et al. A Nationwide Rise in the Use of Stents for Benign Esophageal Perforation. Ann Thorac Surg 2017; 104:227.
  46. White RE, Mungatana C, Topazian M. Expandable stents for iatrogenic perforation of esophageal malignancies. J Gastrointest Surg 2003; 7:715.
  47. Johnsson E, Lundell L, Liedman B. Sealing of esophageal perforation or ruptures with expandable metallic stents: a prospective controlled study on treatment efficacy and limitations. Dis Esophagus 2005; 18:262.
  48. van Heel NC, Haringsma J, Spaander MC, et al. Short-term esophageal stenting in the management of benign perforations. Am J Gastroenterol 2010; 105:1515.
  49. Fischer A, Thomusch O, Benz S, et al. Nonoperative treatment of 15 benign esophageal perforations with self-expandable covered metal stents. Ann Thorac Surg 2006; 81:467.
  50. Freeman RK, Van Woerkom JM, Ascioti AJ. Esophageal stent placement for the treatment of iatrogenic intrathoracic esophageal perforation. Ann Thorac Surg 2007; 83:2003.
  51. Salminen P, Gullichsen R, Laine S. Use of self-expandable metal stents for the treatment of esophageal perforations and anastomotic leaks. Surg Endosc 2009; 23:1526.
  52. Schmidt SC, Strauch S, Rösch T, et al. Management of esophageal perforations. Surg Endosc 2010; 24:2809.
  53. Kiev J, Amendola M, Bouhaidar D, et al. A management algorithm for esophageal perforation. Am J Surg 2007; 194:103.
  54. Leers JM, Vivaldi C, Schäfer H, et al. Endoscopic therapy for esophageal perforation or anastomotic leak with a self-expandable metallic stent. Surg Endosc 2009; 23:2258.
  55. Qadeer MA, Dumot JA, Vargo JJ, et al. Endoscopic clips for closing esophageal perforations: case report and pooled analysis. Gastrointest Endosc 2007; 66:605.
  56. Raju GS, Thompson C, Zwischenberger JB. Emerging endoscopic options in the management of esophageal leaks (videos). Gastrointest Endosc 2005; 62:278.
  57. Wewalka FW, Clodi PH, Haidinger D. Endoscopic clipping of esophageal perforation after pneumatic dilation for achalasia. Endoscopy 1995; 27:608.
  58. Cipolletta L, Bianco MA, Rotondano G, et al. Endoscopic clipping of perforation following pneumatic dilation of esophagojejunal anastomotic strictures. Endoscopy 2000; 32:720.
  59. Abe N, Sugiyama M, Hashimoto Y, et al. Endoscopic nasomediastinal drainage followed by clip application for treatment of delayed esophageal perforation with mediastinitis. Gastrointest Endosc 2001; 54:646.
  60. Shimizu Y, Kato M, Yamamoto J, et al. Endoscopic clip application for closure of esophageal perforations caused by EMR. Gastrointest Endosc 2004; 60:636.
  61. Gerke H, Crowe GC, Iannettoni MD. Endoscopic closure of cervical esophageal perforation caused by traumatic insertion of a mucosectomy cap. Ann Thorac Surg 2007; 84:296.
  62. Weiland T, Fehlker M, Gottwald T, Schurr MO. Performance of the OTSC System in the endoscopic closure of iatrogenic gastrointestinal perforations: a systematic review. Surg Endosc 2013; 27:2258.
  63. Botoman VA, Surawicz CM. Bacteremia with gastrointestinal endoscopic procedures. Gastrointest Endosc 1986; 32:342.
  64. Niv Y, Bat L, Motro M. Bacterial endocarditis after Hurst bougienage in a patient with a benign esophageal stricture and mitral valve prolapse. Gastrointest Endosc 1985; 31:265.
  65. Antibiotic prophylaxis for gastrointestinal endoscopy. American Society for Gastrointestinal Endoscopy. Gastrointest Endosc 1995; 42:630.
  66. Kozarek RA. Hydrostatic balloon dilation of gastrointestinal stenoses: a national survey. Gastrointest Endosc 1986; 32:15.
  67. Shemesh E, Czerniak A. Comparison between Savary-Gilliard and balloon dilatation of benign esophageal strictures. World J Surg 1990; 14:518.
  68. Saeed ZA, Winchester CB, Ferro PS, et al. Prospective randomized comparison of polyvinyl bougies and through-the-scope balloons for dilation of peptic strictures of the esophagus. Gastrointest Endosc 1995; 41:189.
  69. Lanza FL, Graham DY. Bougienage is effective therapy for most benign esophageal strictures. JAMA 1978; 240:844.