Traversing Difficult Esophageal Strictures from the Oral Approach

Most benign esophageal strictures are treated by endoscopic dilation while malignant strictures are frequently treated by placement of an expandable stent. In both situations the ability to traverse these strictures is necessary. Complex strictures are more difficult to negotiate with conventional endoscopes and may require fluoroscopic guidance and specialized endoscopic techniques to traverse. Fortunately, a number of endoscopic techniques are available to successfully traverse these complete stenoses and allow the reestablishment of luminal continuity for subsequent standard dilation. In this article the tools and methods that are used to endoscopically traverse and treat esophageal strictures is presented and an algorithmic approach to managing strictures based on structural complexity is also proposed.