Guideline sources The following summarized guidelines for the management of esophageal stricture are prepared by our editorial team based on guidelines from the American Society for Gastrointestinal Endoscopy (ASGE 2014). 1 2 2 3 4 Definition Esophageal stricture is a chronic condition characterized by dysphagia due to esophageal inflammation, collagen deposition and scar tissue. 2 Epidemiology Esophageal stricture is caused mainly by GERD, esophagitis, tumors (adenocarcinoma, SCC), corrosive injury to the esophagus, intrinsic/extrinsic compressions, Plummer-Vinson syndrome, postsurgical complications, and congenital defects. 3 Disease course Clinical manifestations of an esophageal stricture include dysphagia, gastroesophageal reflux, vomiting, chest pain, cough, hoarseness, gastrointestinal bleeding, anemia, and weight loss. There is an increased risk of recurrence after initial dilatation. 2 Prognosis and risk of recurrence In-hospital mortality in benign and malignant esophageal strictures is 1.4% and 3.1%, respectively. 4 Guidelines https://web.pathway.md/diseases/rechN2bT9lWPOjuu1 1/3 6/29/23, 4:19 AM Esophageal stricture Pathway 1. Medical management Antisecretory treatment: initiate antisecretory treatment in patients undergoing endoscopic dilation for a peptic esophageal stricture, in order to reduce the risk of recurrent strictures. A Adjunctive corticosteroid injections: consider performing intralesional corticosteroid injection as adjunctive treatment for patients with recurrent or refractory benign esophageal peptic strictures. C 2. Therapeutic procedures Endoscopic dilation: perform endoscopic dilation for patients with dysphagia secondary to benign intrinsic strictures of the esophagus. A Show 2 more Esophageal stent placement: consider performing esophageal stent placement only in patients with refractory esophageal strictures that do not respond to sequential dilation and/or intralesional corticosteroid injection. C Clinical findings Symptoms Past medical history Burning sensation Cancer Choking and coughing fits Esophageal tumors Dysphagia Exposure to radiation therapy Epigastric abdominal pain Gastroesophageal reflux Food impaction Hiatal hernia Medications Past surgical history Peptic ulcer disease Recent surgery Social history Alcohol consumption References 1. Pasha SF, Acosta RD, Chandrasekhara V et al. The role of endoscopy in the evaluation and management of dysphagia. Gastrointest Endosc. 2014 Feb;79 2 191 201. Open 2. Ana Ruig mez, Luis Alberto Garc a Rodr guez, Mari-Ann Wallander et al. Esophageal stricture: incidence, treatment patterns, and recurrence rate. Am J Gastroenterol. 2006 Dec;101 12 2685 92. Open 3. D W McBride Jr, S D Roper. Ca(2+)-dependent chloride conductance in Necturus taste cells. 1991 Oct;124 1 85 93.1991 Oct;124 1 85 93. Open 4. Abhinav Goyal, Kshitij Chatterjee, Sujani Yadlapati et al. Health-Care Utilization and Complications of Endoscopic Esophageal Dilation in a National Population. 2017 Jul;50 4 366 371.2017 Jul;50 4 366 371. Open https://web.pathway.md/diseases/rechN2bT9lWPOjuu1 2/3 6/29/23, 4:19 AM Esophageal stricture Pathway 5. Abhinav Goyal, Kshitij Chatterjee, Sujani Yadlapati et al. Health-Care Utilization and Complications of Endoscopic Esophageal Dilation in a National Population. Clin Endosc. 2017 Jul; 50 4 366 371. Open https://web.pathway.md/diseases/rechN2bT9lWPOjuu1 3/3