Endoscopic Management of Esophageal Strictures

Abstract

Introduction: The management of esophageal strictures has significantly evolved, marked by a shift from traditional surgical interventions to innovative and less invasive endoscopic techniques. This review aims to synthesize the literature on these advancements, highlighting key findings that shape current clinical practice.

Methods: This review analyzes evidence from various studies, including a case report on dynamic stenting , a national population study on healthcare utilization and complications of endoscopic dilation , a systematic review on double-balloon enteroscopy-assisted dilatation , a prospective randomized trial on intralesional steroid injections , an economic analysis of lumen-apposing metal stents (LAMS) , and reports on novel techniques like flexible endoscopy and electrocautery incisional therapy.

Results: Endoscopic dilation is established as the first-line treatment for benign esophageal strictures. For refractory or recurrent cases, temporary stenting and the use of LAMS have proven effective. Adjunctive therapies, such as intralesional steroid injections following dilation, improve outcomes in complex strictures. Novel techniques, including flexible endoscopic management for tight corrosive strictures and electrocautery incisional therapy for refractory anastomotic strictures, have demonstrated safety and efficacy. Esophageal perforation remains the most serious complication of dilation.

Discussion: The move toward endoscopic techniques is driven by lower complication rates and faster recovery compared to surgery. However, managing recurrent strictures remains a significant challenge. The integration of newer technologies like LAMS is supported by long-term cost-effectiveness despite higher initial costs. Complex and refractory cases often require specialized management in tertiary care centers, necessitating individualized treatment strategies.

Conclusion: The literature confirms that endoscopic management of esophageal strictures has advanced significantly, offering effective, safe, and economically viable alternatives to surgery. Continued research and innovation in endoscopic techniques and adjunctive therapies are essential for optimizing patient outcomes.