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Benign oesophageal strictures may have several attributable causes including caustic injuries, long-term acid reflux, eosinophilic oesophagitis, anastomotic strictures and endoscopic therapy. Endoscopic dilation via bougies or balloon dilators may treat most strictures successfully and satisfactorily. However, in some situations treatment may result in recurrent or refractory strictures. The authors of this paper provide a useful overview of treatment options for the management of benign strictures. The authors suggest a comprehensive diagnostic approach and careful history to exclude malignancy and obtain baseline information including a nutritional assessment. They present a useful Classification Table distinguishing simple vs. complex strictures based on aetiology, diameter, length and location of stricture. Whilst most simple strictures can be readily managed with endoscopic dilation, complex strictures require a variety of other creative solutions. This may include options such as the “rendezvous approach” where retrograde endoscopy via a PEG tube and anterograde visualisation are used in combination to puncture and dilate the stenotic segment. The authors suggest the term ‘recurrent stricture’ may be used to refer to cases where a luminal diameter of 14mm cannot be maintained for four weeks. Refractory benign oesophageal stricture may be used when there is persistent dysphagia despite a minimum of five sessions with dilation to at least 14mm. In such cases, the authors make clinical suggestions based on their review of the literature. This includes dilation, dilation combined with drug injection, incisional therapy and the use of stents. They also discuss paediatric oesophageal strictures and suggest management options for this population. A treatment algorithm is a useful addition in this paper and may serve as a guide on next steps if first line bougie or balloon dilation is unsuccessful in alleviating symptoms of dysphagia.

Endoscopic management of refractory benign oesophageal strictures.
Fugazza A and Repicci A.
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Roganie Govender

University College London, Head & Neck Academic Centre, UK.

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