Esophageal Strictures Refractory to Endoscopic Dilatation

Esophageal stricture is a common issue faced by clinicians who care for patients with foregut disorders. Generally, strictures can be effectively managed using endoscopic techniques such as dilation. Improved control of the primary pathology, in most cases gastroesophageal reflux disease (GERD), is also typically effective in limiting recurrence of a stricture after therapy. However, while many strictures are effectively managed with simple dilatation, a minority remain refractory to treatment, posing a particularly difficult challenge to both the patient and the physician. We define such a “refractory” esophageal stricture if one or more of the following criteria are met: (1) failure to achieve an adequate luminal diameter to allow intake of solid food without dysphagia despite up to four repeat dilatations at 2-week intervals or (2) stricture which requires surgical intervention at any point. While such strictures can be challenging to manage, a thoughtful and systematic approach can allow the restoration of good swallowing function for the patient.