Benign esophageal stricture: etiology and management

Objective: Benign lesion obstructing the esophagus or inducing inflammatory/fibrotic changes in the esophagus can lead to esophageal strictures. These impact patient’s well‐being, malnutrition, aspiration, pain and respiratory failure. It is difficult to manage conservatively and needs intervention to ameliorate dysphagia or treat complications. Minimally‐invasive treatment modalities are available to treat benign strictures of the esophagus. This study aims to evaluate the etiology and management options of benign esophageal stricture patients at Gastrointestinal Endoscopy Center, Cipto Mangunkusumo National General Hospital, Jakarta, from 2015 to 2018.
Methods: This retrospective cross‐sectional study extracted registry data of newly diagnosed benign esophageal strictures patients between 2015 to 2018 from the Gastrointestinal Endoscopy Center, Cipto Mangunkusumo National General Hospital, Jakarta. All data retrieved from patient’s medical record either etiology or treatment procedures underwent in every patient.
Results: We found 20 newly diagnosed benign esophageal stricture cases. The mean age at diagnosis was 31 years old, 50% were male, 20% were Javanese ethnic. All patients came with dysphagia, and esophageal dilation procedure was performed using through‐the‐scope esophageal balloon dilator. About 35% patients underwent repeated dilation of esophagus more than 20 times after the diagnosis was established, and a few patients combined with topical triamcinolone injection.
Discussion: Benign esophageal strictures arise from a variety of causes: radiation therapy, peptic stricture due to gastroesophageal reflux disease, esophageal resection, ablative therapy, or ingestion of corrosive substance. Strictures most successfully treated with endoscopic dilation using through‐the‐scope esophageal balloon dilator. However, about one third of patients have recurrent episodes of dysphagia within the first year. These patients must undergo repeated dilation to relieve the symptoms or receive combination therapy with topical triamcinolone injection.
Conclusion: This study describes the diversity causes of benign esophageal strictures and the proper management to relieve the symptoms and avoid related complications.