The Endoscopic Management of Esophageal Strictures

Factors Influencing Clinical Applications of Endoscopic Balloon Dilation for Benign Esophageal Strictures

“…Through-the-scope (TTS) balloons that can pass through the biopsy channel of standard endoscopes were developed in the mid-1980s. These have the advantage that direct visualization of the stricture is possible during insertion and dilation of the balloon ± avoiding the use of guide wires and associated complications such as incorrect positioning, looping, and perforation during withdrawal of a kinked guide wire [3]. In addition, radiation exposure to both patients and staff is also avoided with balloon dilation, as there is no need for fluoroscopy.…”

“…The principal complications of esophageal dilation are perforation, bleeding, and bacteremia [3,6]. The reported rate of perforation and massive bleeding is approximately 0.3 %.…”

“…The risk is higher when complex strictures (longer, narrower, and more angulated) and lye strictures are being dilated [17]. Transient bacteremia may occur after esophageal dilation, with a reported incidence in the range of 0 ± 54 % [3,18,19]. However, the role of prophylactic antibiotic treatment before esophageal dilation is still controversial, except in patients with a prosthetic heart valve, a history of endocarditis, or those with surgically constructed systemic/pulmonary shunts or conduits, in whom antibiotic prophylaxis is recommended [20].…”

“…One of the most common causes of benign esophageal strictures is reflux esophagitis (70 %) [2]. Caustic injury, surgical anastomotic stricture, radiation stricture, pill-induced stricture, chemotherapyinduced stricture, and post-sclerotherapy stricture have also been reported [3].…”

“…Nonsurgical treatment is now carried out for benign esophageal strictures in the majority of cases, with only 5 ± 15 % of patients requiring surgery [3]. Nonsurgical forms of treatment include mercury bougienage (Maloney, Hurst), hollow polyvinyl bougienage (Savary/Gilliard), metal olive bougienage (Eder/Puestow), and balloon dilators.…”