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

Dayna Early_Esophageal Strictures and Management

Pdf Summary

Esophageal strictures are characterized based on their location, inflammation, number, and complexity. Simple strictures are smooth, short, straight, and allow the passage of an endoscope. Complex strictures are longer, angulated, irregular, and severely narrowed. They are associated with conditions like hiatal hernia, esophageal diverticula, or tracheoesophageal fistula.<br /><br />Management of esophageal strictures involves both medical and endoscopic approaches. Medications like acid suppression and steroids are used to treat inflammation. Endoscopic dilation is performed using different techniques. Savary dilation is used for multiple or proximal strictures, while balloon dilation is preferred for single or mid and distal strictures. Balloon dilators come in multiple sizes and can be inflated to different diameters. They allow for multi-sized dilations in a single placement and provide direct visualization of the stricture.<br /><br />The "rule of 3" is often followed during esophageal dilation, which limits the number of dilators passed to three. This practice, although widely accepted, lacks evidence-based support. Another treatment option for refractory strictures is steroid injection therapy, which has shown to prolong the time to repeat dilation.<br /><br />In summary, it is important to characterize strictures before choosing the appropriate treatment method. Dilations are usually necessary along with medical therapy. Wire-guided polyvinyl dilators provide radial and longitudinal dilation but cannot be visualized. Balloon dilators allow for incremental dilation and visualization. Steroid injection therapy should be considered for refractory strictures.

Keywords

Esophageal strictures

simple strictures

complex strictures

hiatal hernia

esophageal diverticula

tracheoesophageal fistula

endoscopic dilation

Savary dilation

balloon dilation

steroid injection therapy