Esophageal strictures: Management beyond dilation

Esophageal stricture refers to a pathological narrowing of the esophageal lumen, causing dysphagia and impairing the patient's quality of life. There are various etiologies including esophageal malignancy, peptic injury, caustic ingestion, post-surgical anastomosis, radiation therapy, and inflammatory disorders such as eosinophilic esophagitis. The primary goal in managing esophageal strictures is to relieve dysphagia by maintaining luminal patency. Endoscopic dilation remains the mainstay of treatment for most benign strictures, with either bougie or balloon dilators. For patients who develop refractory or recurrent strictures that are difficult to manage with dilation alone, adjunctive therapies like intralesional steroid injections, topical or injected mitomycin C, incisional therapy, stent placement, and finally surgery may enhance outcomes and reduce the frequency of repeat procedures. The present review focuses on the basics of dilation and adjunctive strategies for the management of esophageal stricture.