Endoscopic Management of the Difficult Benign Esophageal Stricture

The incidence of benign esophageal strictures is decreasing, likely due to the widespread use of proton pump inhibitors. Although most strictures respond well to dilation, a minority of them, mostly those of nonpeptic origin, may be difficult to manage. Challenges include the need for repeat dilations, not being able to reach a minimum diameter, and inability to provide significant symptomatic relief. The mainstay of management of benign esophageal strictures is esophageal dilation. Several techniques for dilation exist. The use of a specific dilation technique is dictated by the character of the stricture. Adjuncts to the management of difficult benign esophageal strictures include steroid injection, use of cautery, and more recently, the use of removable stents. As a result of these improvements on endoscopic techniques, the indications for surgical intervention in difficult esophageal strictures are changing and likely will decrease in the future.