Management of Chronic Refractory Oesophageal Strictures

AbstractPurpose of reviewBenign oesophageal strictures are commonly encountered in endoscopy. Although most strictures are successfully treated with endoscopic dilatation, up to 40% of patients may develop refractory strictures which require repeated long-term endoscopic intervention with an adverse impact on their quality of life. This review summarises the current evidence-based treatment options available for these patients including preliminary data on novel interventions for this difficult to treat cohort of patients.Recent findingsOnly one-third of patients with refractory oesophageal strictures are able to escape the need for repeated long-term endoscopic dilatation. It has been shown however that dilatation up to a target diameter of 16 –18 mm can reduce the need for further dilatations. Incisional therapy is a useful alternative treatment option for anastomotic strictures as is temporary placement of a lumen-apposing metal stent. Although biodegradable stents appear promising in the short-term, longer-term data and pain may limi t their use. Self-dilatation appears to be a useful approach for motivated patients with short, proximal strictures.SummaryAlthough refractory oesophageal strictures are challenging to treat, numerous endoscopic treatment options are now available that usually prevent patients needing more radical surgical intervention.
Source: Current Treatment Options in Gastroenterology - Category: Gastroenterology Source Type: research