Esophageal
strictures are a problem commonly encountered in gastroenterological practice and can be caused by malignant or benign lesions.
Dysphagia is the symptom experienced by all patients, regardless of whether their
strictures are caused by malignant or benign lesions. The methods most frequently used for palliation of malignant esophageal
strictures are
stent placement (particularly in patients with an expected survival of 3 months or less) and
brachytherapy (in patients with a life expectancy of more than 3 months).
Brachytherapy has been shown to be beneficial in patients with an expected survival of longer than 3 months with regard to (prolonged)
dysphagia improvement, complications and quality of life. The mainstay of benign
esophageal stricture treatment is dilation. Although dilation usually results in symptomatic relief, recurrent
strictures do occur. In order to predict which types of
strictures are most likely to recur, it is important to differentiate between esophageal
strictures that are simple (i.e. focal, straight
strictures with a diameter that allows
endoscope passage) and those that are more complex (i.e. long (>2 cm), tortuous
strictures with a narrow diameter). These complex
strictures are considered refractory when they cannot be dilated to an adequate diameter. Novel treatment modalities for refractory
strictures include temporary
stent placement and incisional
therapy.