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

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