Management of Esophageal Peptic Stricture

  • Jeffrey W. HazeyEmail author
  • Mazen R. Al-Mansour


Esophageal peptic stricture is a manifestation of long-standing gastroesophageal reflux disease. It usually involves the distal esophagus and results from chronic exposure of the lower esophagus to the acidic gastric fluid. Dysphagia is the most common presenting symptom. Gastric acid suppression with mechanical dilation (bougienage) or balloon dilation is the mainstay of therapy. Both forms of dilation are highly effective in treating the stricture and resolving the dysphagia. Recalcitrant strictures can be treated by intramucosal steroid injection or esophageal stent placement.


Esophageal stricture Peptic stricture Gastroesophageal reflux disease GERD GORD Esophageal dilation 


  1. 1.
    Ruigómez A, García Rodríguez LA, Wallander M-A, Johansson S, Eklund S. Esophageal stricture: incidence, treatment patterns, and recurrence rate. Am J Gastroenterol. 2006;101:2685–92.CrossRefGoogle Scholar
  2. 2.
    Marks RD, Richter JE. Peptic strictures of the esophagus. Am J Gastroenterol. 1993;88:1160–73.PubMedGoogle Scholar
  3. 3.
    Ahtaridis G, Snape WJ, Cohen S. Clinical and manometric findings in benign peptic strictures of the esophagus. Dig Dis Sci. 1979;24:858–61.CrossRefGoogle Scholar
  4. 4.
    Spiess AE, Kahrilas PJ. Treating achalasia: from whalebone to laparoscope. JAMA. 1998;280:638–42.CrossRefGoogle Scholar
  5. 5.
    Ferguson DD. Evaluation and management of benign esophageal strictures. Dis Esophagus Off J Int Soc Dis Esophagus. 2005;18:359–64.CrossRefGoogle Scholar
  6. 6.
    Abele JE. The physics of esophageal dilatation. Hepato-Gastroenterology. 1992;39:486–9.PubMedGoogle Scholar
  7. 7.
    McLean GK, LeVeen RF. Shear stress in the performance of esophageal dilation: comparison of balloon dilation and bougienage. Radiology. 1989;172:983–6.CrossRefGoogle Scholar
  8. 8.
    Wilson W, Taubert KA, Gewitz M, Lockhart PB, Baddour LM, Levison M, Bolger A, Cabell CH, Takahashi M, Baltimore RS, Newburger JW, Strom BL, Tani LY, Gerber M, Bonow RO, Pallasch T, Shulman ST, Rowley AH, Burns JC, Ferrieri P, Gardner T, Goff D, Durack DT, American Heart Association Rheumatic Fever, Endocarditis, and Kawasaki Disease Committee, American Heart Association Council on Cardiovascular Disease in the Young, American Heart Association Council on Clinical Cardiology, American Heart Association Council on Cardiovascular Surgery and Anesthesia, Quality of Care and Outcomes Research Interdisciplinary Working Group. Prevention of infective endocarditis: guidelines from the American Heart Association: a guideline from the American Heart Association Rheumatic Fever, Endocarditis, and Kawasaki Disease Committee, Council on Cardiovascular Disease in the Young, and the Council on Clinical Cardiology, Council on Cardiovascular Surgery and Anesthesia, and the Quality of Care and Outcomes Research Interdisciplinary Working Group. Circulation. 2007;116:1736–54.CrossRefGoogle Scholar
  9. 9.
    ASGE STANDARDS OF PRACTICE COMMITTEE, Banerjee S, Shen B, Baron TH, Nelson DB, Anderson MA, Cash BD, Dominitz JA, Gan SI, Harrison ME, Ikenberry SO, Jagannath SB, Lichtenstein D, Fanelli RD, Lee K, van Guilder T, Stewart LE. Antibiotic prophylaxis for GI endoscopy. Gastrointest Endosc. 2008;67:791–8.CrossRefGoogle Scholar
  10. 10.
    Kozarek RA, Patterson DJ, Ball TJ, Gelfand MG, Jiranek GE, Bredfeldt JE, Brandabur JJ, Wolfsen HW, Raltz SL. Esophageal dilation can be done safely using selective fluoroscopy and single dilating sessions. J Clin Gastroenterol. 1995;20:184–8.CrossRefGoogle Scholar
  11. 11.
    Ho SB, Cass O, Katsman RJ, Lipschultz EM, Metzger RJ, Onstad GR, Silvis SE. Fluoroscopy is not necessary for Maloney dilation of chronic esophageal strictures. Gastrointest Endosc. 1995;41:11–4.CrossRefGoogle Scholar
  12. 12.
    McClave SA, Brady PG, Wright RA, Goldschmid S, Minocha A. Does fluoroscopic guidance for Maloney esophageal dilation impact on the clinical endpoint of therapy: relief of dysphagia and achievement of luminal patency. Gastrointest Endosc. 1996;43:93–7.CrossRefGoogle Scholar
  13. 13.
    Tucker LE. The importance of fluoroscopic guidance for Maloney dilation. Am J Gastroenterol. 1992;87:1709–11.PubMedGoogle Scholar
  14. 14.
    Wang Y-G, Tio T-L, Soehendra N. Endoscopic dilation of esophageal stricture without fluoroscopy is safe and effective. World J Gastroenterol. 2002;8:766–8.CrossRefGoogle Scholar
  15. 15.
    Raymondi R, Pereira-Lima JC, Valves A, Morales GF, Marques D, Lopes CV, Marroni CA. Endoscopic dilation of benign esophageal strictures without fluoroscopy: experience of 2750 procedures. Hepato-Gastroenterology. 2008;55:1342–8.PubMedGoogle Scholar
  16. 16.
    Kabbaj N, Salihoun M, Chaoui Z, Acharki M, Amrani N. Safety and outcome using endoscopic dilatation for benign esophageal stricture without fluoroscopy. World J Gastrointest Pharmacol Ther. 2011;2:46–9.CrossRefGoogle Scholar
  17. 17.
    Saeed ZA. Balloon dilatation of benign esophageal stenoses. Hepato-Gastroenterology. 1992;39:490–3.PubMedGoogle Scholar
  18. 18.
    Riley SA, Attwood SEA. Guidelines on the use of oesophageal dilatation in clinical practice. Gut. 2004;53(Suppl 1):i1–6.CrossRefGoogle Scholar
  19. 19.
    Scolapio JS, Pasha TM, Gostout CJ, Mahoney DW, Zinsmeister AR, Ott BJ, Lindor KD. A randomized prospective study comparing rigid to balloon dilators for benign esophageal strictures and rings. Gastrointest Endosc. 1999;50:13–7.CrossRefGoogle Scholar
  20. 20.
    Shemesh E, Czerniak A. Comparison between Savary-Gilliard and balloon dilatation of benign esophageal strictures. World J Surg. 1990;14:518–21; discussion 521–522CrossRefGoogle Scholar
  21. 21.
    Saeed ZA, Winchester CB, Ferro PS, Michaletz PA, Schwartz JT, Graham DY. Prospective randomized comparison of polyvinyl bougies and through-the-scope balloons for dilation of peptic strictures of the esophagus. Gastrointest Endosc. 1995;41:189–95.CrossRefGoogle Scholar
  22. 22.
    Cox JG, Winter RK, Maslin SC, Dakkak M, Jones R, Buckton GK, Hoare RC, Dyet JF, Bennett JR. Balloon or bougie for dilatation of benign esophageal stricture? Dig Dis Sci. 1994;39:776–81.CrossRefGoogle Scholar
  23. 23.
    Hernandez LV, Jacobson JW, Harris MS, Hernandez LJ. Comparison among the perforation rates of Maloney, balloon, and savary dilation of esophageal strictures. Gastrointest Endosc. 2000;51:460–2.CrossRefGoogle Scholar
  24. 24.
    Mandelstam P, Sugawa C, Silvis SE, Nebel OT, Rogers BH. Complications associated with esophagogastroduodenoscopy and with esophageal dilation. Gastrointest Endosc. 1976;23:16–9.CrossRefGoogle Scholar
  25. 25.
    Piotet E, Escher A, Monnier P. Esophageal and pharyngeal strictures: report on 1,862 endoscopic dilatations using the Savary-Gilliard technique. Eur Arch Otorhinolaryngol. 2008;265:357–64.CrossRefGoogle Scholar
  26. 26.
    Silvis SE, Nebel O, Rogers G, Sugawa C, Mandelstam P. Endoscopic complications. Results of the 1974 American Society for Gastrointestinal Endoscopy Survey. JAMA. 1976;235:928–30.CrossRefGoogle Scholar
  27. 27.
    Brinster CJ, Singhal S, Lee L, Marshall MB, Kaiser LR, Kucharczuk JC. Evolving options in the management of esophageal perforation. Ann Thorac Surg. 2004;77:1475–83.CrossRefGoogle Scholar
  28. 28.
    Botoman VA, Surawicz CM. Bacteremia with gastrointestinal endoscopic procedures. Gastrointest Endosc. 1986;32:342–6.CrossRefGoogle Scholar
  29. 29.
    Nelson DB, Sanderson SJ, Azar MM. Bacteremia with esophageal dilation. Gastrointest Endosc. 1998;48:563–7.CrossRefGoogle Scholar
  30. 30.
    Bautista-Casasnovas A, Varela-Cives R, Estévez Martínez E, Jardón Bahía JA, Barca PR, Dargallo Carbonell T, Villanueva Jeremias A, Cadranel S, Tojo R. What is the infection risk of oesophageal dilatations? Eur J Pediatr. 1998;157:901–3.CrossRefGoogle Scholar
  31. 31.
    Patterson DJ, Graham DY, Smith JL, Schwartz JT, Alpert E, Lanza FL, Cain GD. Natural history of benign esophageal stricture treated by dilatation. Gastroenterology. 1983;85:346–50.PubMedGoogle Scholar
  32. 32.
    Glick ME. Clinical course of esophageal stricture managed by bougienage. Dig Dis Sci. 1982;27:884–8.CrossRefGoogle Scholar
  33. 33.
    Marks RD, Richter JE, Rizzo J, Koehler RE, Spenney JG, Mills TP, Champion G. Omeprazole versus H2-receptor antagonists in treating patients with peptic stricture and esophagitis. Gastroenterology. 1994;106:907–15.CrossRefGoogle Scholar
  34. 34.
    Smith PM, Kerr GD, Cockel R, Ross BA, Bate CM, Brown P, Dronfield MW, Green JR, Hislop WS, Theodossi A. A comparison of omeprazole and ranitidine in the prevention of recurrence of benign esophageal stricture. Restore Investigator Group. Gastroenterology. 1994;107:1312–8.CrossRefGoogle Scholar
  35. 35.
    Silvis SE, Farahmand M, Johnson JA, Ansel HJ, Ho SB. A randomized blinded comparison of omeprazole and ranitidine in the treatment of chronic esophageal stricture secondary to acid peptic esophagitis. Gastrointest Endosc. 1996;43:216–21.CrossRefGoogle Scholar
  36. 36.
    Swarbrick ET, Gough AL, Foster CS, Christian J, Garrett AD, Langworthy CH. Prevention of recurrence of oesophageal stricture, a comparison of lansoprazole and high-dose ranitidine. Eur J Gastroenterol Hepatol. 1996;8:431–8.PubMedGoogle Scholar
  37. 37.
    Said A, Brust DJ, Gaumnitz EA, Reichelderfer M. Predictors of early recurrence of benign esophageal strictures. Am J Gastroenterol. 2003;98:1252–6.CrossRefGoogle Scholar
  38. 38.
    Dzeletovic I, Fleischer DE, Crowell MD, Pannala R, Harris LA, Ramirez FC, Burdick GE, Rentz LA, Spratley RV, Helling SD, Alexander JA. Self-dilation as a treatment for resistant, benign esophageal strictures. Dig Dis Sci. 2013;58:3218–23.CrossRefGoogle Scholar
  39. 39.
    Grobe JL, Kozarek RA, Sanowski RA. Self-bougienage in the treatment of benign esophageal stricture. J Clin Gastroenterol. 1984;6:109–12.CrossRefGoogle Scholar
  40. 40.
    Orive-Calzada A, Bernal-Martinez A, Navajas-Laboa M, Torres-Burgos S, Aguirresarobe M, Lorenzo-Morote M, Arevalo-Serna JA, Cabriada-Nuño JL. Efficacy of intralesional corticosteroid injection in endoscopic treatment of esophageal strictures. Surg Laparosc Endosc Percutan Tech. 2012;22:518–22.CrossRefGoogle Scholar
  41. 41.
    Kochhar R, Ray JD, Sriram PV, Kumar S, Singh K. Intralesional steroids augment the effects of endoscopic dilation in corrosive esophageal strictures. Gastrointest Endosc. 1999;49:509–13.CrossRefGoogle Scholar
  42. 42.
    Kirsch M, Blue M, Desai RK, Sivak MV. Intralesional steroid injections for peptic esophageal strictures. Gastrointest Endosc. 1991;37:180–2.CrossRefGoogle Scholar
  43. 43.
    Russell SB, Trupin JS, Myers JC, Broquist AH, Smith JC, Myles ME, Russell JD. Differential glucocorticoid regulation of collagen mRNAs in human dermal fibroblasts. Keloid-derived and fetal fibroblasts are refractory to down- regulation. J Biol Chem. 1989;264:13730–5.PubMedGoogle Scholar
  44. 44.
    Ramage JI, Rumalla A, Baron TH, Pochron NL, Zinsmeister AR, Murray JA, Norton ID, Diehl N, Romero Y. A prospective, randomized, double-blind, placebo- controlled trial of endoscopic steroid injection therapy for recalcitrant esophageal peptic strictures. Am J Gastroenterol. 2005;100:2419–25.CrossRefGoogle Scholar
  45. 45.
    Spaander MCW, Baron TH, Siersema PD, Fuccio L, Schumacher B, Escorsell À, Garcia-Pagán J-C, Dumonceau J-M, Conio M, de Ceglie A, Skowronek J, Nordsmark M, Seufferlein T, Van Gossum A, Hassan C, Repici A, Bruno MJ. Esophageal stenting for benign and malignant disease: European Society of Gastrointestinal Endoscopy (ESGE) Clinical Guideline. Endoscopy. 2016;48:939–48.CrossRefGoogle Scholar
  46. 46.
    Gangloff A, Lecleire S, Di Fiore A, Huet E, Iwanicki-Caron I, Antonietti M, Michel P. Fully versus partially covered self-expandable metal stents in benign esophageal strictures. Dis Esophagus. 2015;28:678–83.CrossRefGoogle Scholar
  47. 47.
    Dua KS, Vleggaar FP, Santharam R, Siersema PD. Removable self- expanding plastic esophageal stent as a continuous, non-permanent dilator in treating refractory benign esophageal strictures: a prospective two-center study. Am J Gastroenterol. 2008;103:2988–94.CrossRefGoogle Scholar
  48. 48.
    Holm AN, de la Mora Levy JG, Gostout CJ, Topazian MD, Baron TH. Self- expanding plastic stents in treatment of benign esophageal conditions. Gastrointest Endosc. 2008;67:20–5.Google Scholar
  49. 49.
    Evrard S, Le Moine O, Lazaraki G, Dormann A, El Nakadi I, Devière J. Self- expanding plastic stents for benign esophageal lesions. Gastrointest Endosc. 2004;60:894–900.CrossRefGoogle Scholar
  50. 50.
    Repici A, Hassan C, Sharma P, Conio M, Siersema P. Systematic review: the role of self-expanding plastic stents for benign oesophageal strictures. Aliment Pharmacol Ther. 2010;31:1268–75.CrossRefGoogle Scholar
  51. 51.
    Song HY, Jung HY, Park SI, Kim SB, Lee DH, Kang SG, Il Min Y. Covered retrievable expandable nitinol stents in patients with benign esophageal strictures: initial experience. Radiology. 2000;217:551–7.CrossRefGoogle Scholar
  52. 52.
    Fuccio L, Hassan C, Frazzoni L, Miglio R, Repici A. Clinical outcomes following stent placement in refractory benign esophageal stricture: a systematic review and meta-analysis. Endoscopy. 2016;48:141–8.PubMedGoogle Scholar
  53. 53.
    Samanta J, Dhaka N, Sinha SK, Kochhar R. Endoscopic incisional therapy for benign esophageal strictures: technique and results. World J Gastrointest Endosc. 2015;7:1318–26.CrossRefGoogle Scholar
  54. 54.
    Lee WK, Kim BS, Yang MA, Yun SH, Lee YJ, Kim JW, Cho JW. An intractable caustic esophageal stricture successfully managed with sequential treatment comprising incision with an insulated-tip knife, balloon dilation, and an oral steroid. Clin Endosc. 2016;49:560.CrossRefGoogle Scholar
  55. 55.
    Simmons DT, Baron TH. Electroincision of refractory esophagogastric anastomotic strictures. Dis Esophagus. 2006;19:410–4.CrossRefGoogle Scholar
  56. 56.
    Rosseneu S, Afzal N, Yerushalmi B, Ibarguen-Secchia E, Lewindon P, Cameron D, Mahler T, Schwagten K, Köhler H, Lindley KJ, Thomson M. Topical application of mitomycin-C in oesophageal strictures. J Pediatr Gastroenterol Nutr. 2007;44:336–41.CrossRefGoogle Scholar
  57. 57.
    Deng H-Y, Wang W-P, Lin Y-D, Chen L-Q. Can mitomycin facilitate endoscopic dilatation treatment of benign oesophageal stricture? Interact Cardiovasc Thorac Surg. 2017;24(1):112–4.CrossRefGoogle Scholar

Copyright information

© SAGES 2019

Authors and Affiliations

  1. 1.Division of General and Gastrointestinal Surgery, Department of SurgeryThe Ohio State University, Wexner Medical CenterColumbusUSA
  2. 2.Department of General and Gastrointestinal SurgeryThe Ohio State University, Wexner Medical CenterColumbusUSA

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