Editing Oesophageal strictures


== BENIGN aetiology ==

* 75% from chronic GORD
** Smooth, short, straight,      distal oesophagus, can be traversed with endoscope
* 25% secondary to
** External beam radiation
***
** Sclerotherapy
** Caustic ingestions
** Surgical anastomosis
** Dermatologic disease
** External compression
** Eosinophilic oesophagitis -      be very careful dilating - can tear
** These are generally more      difficult to treat (long and narrow strictures)

== EVALUATION ==

* Dysphagia is cardinal feature
* Barium swallow - not     necessarily needed, but should be done with concerns of complex stricture
** Look for location, length,      number of strictures, diameter of lumen, and any associated pathology
* Endoscopy - if concern for     malignancy

== Classification: ==

* Marchand classification

{| class="wikitable"
|Circumferential
|Length
|Consistency
|Grade
|-
|Incomplete

String-like  circumferential

Complete

Complete

Complete
|Short  Short

≤ 1 cm

> 1  cm

> 1  cm
|Fibrotic

Elastic

Fibrotic

Superficial  fibrosis, easily dilated, non-progressive

Deep  fibrosis, tubular, progressive, not easily dilated
|1

2

3

4a

4b
|}

== CONTRAINDICATIONS to dilatation ==

* Acute or incompletely healed     perforation
* Any concern over malignancy
* Bleeding     disorders/respiratory/cardiac are relative contraindications
* Caution - anatomic     deformities, thoracic aneurysm, impacted food bolus
* Eosinophilic oesophagitis

== Dilation ==
No clear preferred type of dilator

Mechanical (push-type or Bougie) dilators

* Various brands

Balloon dilators

* Either through the scope or     over a guidewire

No more than three dilators of progressively increasing diameter should be used per session, and luminal stenosis should be increased by no more than 6Fr

Can be done as frequently as every week

Dilation to 54 Fr (18mm) allows normal diet, generally

70% require repeated dilation

Generally should get a PPI afterwards to prevent recurrence

== REFRACTORY STRICTURES ==

* Intralesional corticosteroid     injection may reduce recurrence - triamcinolone acetonide
* Mitomycin injection -     inhibits fibrosis
* Oesophageal stents
* Home dilation

[[Category:UGIS]]