EGD Masterclass: EoE, Strictures, and Pre-malignant Gastric Conditions (On-demand) | January 2023-Dayna Early

Dayna Early_Esophageal Strictures and Management

Pdf Summary

Esophageal strictures can occur at different parts of the esophagus and can vary in complexity. Simple strictures are short, smooth-surfaced, and allow for the passage of an endoscope. Complex strictures are longer, angulated, and associated with other conditions such as hiatal hernia or diverticula.<br /><br />Management of esophageal strictures involves both medical and endoscopic approaches. Medical treatment includes acid suppression and sometimes the use of steroids. Endoscopic treatment involves dilation of the stricture. There are different methods of dilation, including Savary dilation, balloon dilation, and modification of diet.<br /><br />Balloon dilation is effective for single strictures, as well as mid and distal strictures near the esophagogastric junction. Balloon dilators come in different sizes, allowing for incremental inflation to different sizes. This method also allows for direct visualization of the stricture during the procedure.<br /><br />There is a "rule of 3" that limits the number of dilators passed during a treatment session to a maximum of three. However, the evidence for this rule is limited, and its application to bougie dilation of esophageal strictures is based on expert opinion rather than strong evidence.<br /><br />In some cases, steroid injections into the strictures may be considered for refractory strictures. A study showed that steroid injection combined with balloon dilation resulted in a longer time to repeat dilation compared to a placebo group.<br /><br />In summary, the characterization of strictures is important for choosing the best treatment method. Dilation is usually required along with medical therapy. Balloon dilators allow for visualization and provide incremental dilation. Steroid injection should be considered for refractory strictures.

Keywords

Esophageal strictures

complex strictures

simple strictures

hiatal hernia

diverticula

acid suppression

steroids

endoscopic treatment

Savary dilation

balloon dilation