Esophageal stricture (endoscopic)

The key aim of the endoscopic treatment of oesophageal strictures is the relief of dysphagia. Therefore, to ascertain the success of a procedure, the degree of dysphagia must be carefully assessed before and after. The treatment for benign lesions may simply entail dilatation; for malignant lesions, endoscopic options include thermal tumour ablation and the insertion of prosthetic devices.

Before a therapeutic step is considered, the oesophageal stricture should be evaluated by:

• history and examination
• contrast radiology:
  • 'solid bolus' study, e.g. barium pill
  • motility in supine and erect positions
  • occasionally, with cine fluoroscopy
• prior diagnostic endoscopy with brushings and/or biopsies
• oesophageal manometry: in the case of muscular strictures, e.g. achalasia
• 24-hour ambulatory intra-oesophageal monitoring: if suspected peptic stricture due to reflux