Benign Strictures of the Esophagus, Stomach and Duodenum: Evaluation and Management

  • Vivek KaulEmail author
  • Shivangi T. Kothari


Benign esophageal and foregut strictures are a significant cause of morbidity. The etiologies for benign esophageal strictures range from inflammatory to iatrogenic; dysphagia is the most common presentation. Most underlying causes for esophageal strictures are intrinsic (luminal) although some are extrinsic, related to intramural or mediastinal disease. Gastric and duodenal strictures also have varying etiologies, although the most common presentation is nausea and vomiting due to gastric outlet or small bowel obstruction. Radiologic and endoscopic evaluations are the appropriate investigations that help define the extent and configuration of these strictures. Endoscopic management has emerged as the mainstay of treatment, although in some refractory cases, surgical intervention may be required for definitive treatment. In this chapter, we will review the etiology and the endoscopic approach to the evaluation and management of benign esophageal and foregut strictures.


Esophagus Stricture Stenosis Obstruction Luminal narrowing Dilation Bougie 

Supplementary material

Video 6.1

Benign strictures of the esophagus, stomach and duodenum: evaluation and management (MP4 150094 kb)


  1. 1.
    Richter JE. Peptic strictures of the esophagus. Gastroenterol Clin North Am 1999;28:875–91, vi.Google Scholar
  2. 2.
    Ahtaridis G, Snape WJ Jr, Cohen S. Clinical and manometric findings in benign peptic strictures of the esophagus. Dig Dis Sci. 1979;24:858–61.CrossRefPubMedGoogle Scholar
  3. 3.
    Smith MS. Diagnosis and management of esophageal rings and webs. Gastroenterol Hepatol (N Y). 2010;6:701–4.Google Scholar
  4. 4.
    Schatzki R, Gary JE. Dysphagia due to a diaphragm-like localized narrowing in the lower esophagus (lower esophageal ring). Am J Roentgenol Radium Ther Nucl Med. 1953;70:911–22.PubMedGoogle Scholar
  5. 5.
    Muller M, Gockel I, Hedwig P, et al. Is the Schatzki ring a unique esophageal entity? World J Gastroenterol. 2011;17:2838–43.PubMedPubMedCentralGoogle Scholar
  6. 6.
    Dellon ES, Gonsalves N, Hirano I, et al. ACG clinical guideline: evidenced based approach to the diagnosis and management of esophageal eosinophilia and eosinophilic esophagitis (EoE). Am J Gastroenterol 2013;108:679–92; quiz 693.Google Scholar
  7. 7.
    De Luca L, Bergman JJ, Tytgat GN, et al. EUS imaging of the arteria lusoria: case series and review. Gastrointest Endosc. 2000;52:670–3.CrossRefPubMedGoogle Scholar
  8. 8.
    Bennett JR CD. Overview and symptom assessment. In: Castell DO, Richter JE, editors. The Esophagus. Philadelphia: Lippincott, Williams & Wilkins; 1999. p. 33.Google Scholar
  9. 9.
    Shaheen NJ, Sharma P, Overholt BF, et al. Radiofrequency ablation in Barrett’s esophagus with dysplasia. N Engl J Med. 2009;360:2277–88.CrossRefPubMedGoogle Scholar
  10. 10.
    Seewald S, Akaraviputh T, Seitz U, et al. Circumferential EMR and complete removal of Barrett’s epithelium: a new approach to management of Barrett’s esophagus containing high-grade intraepithelial neoplasia and intramucosal carcinoma. Gastrointest Endosc. 2003;57:854–9.CrossRefPubMedGoogle Scholar
  11. 11.
    Zargar SA, Kochhar R, Nagi B, et al. Ingestion of strong corrosive alkalis: spectrum of injury to upper gastrointestinal tract and natural history. Am J Gastroenterol. 1992;87:337–41.PubMedGoogle Scholar
  12. 12.
    Shone DN, Nikoomanesh P, Smith-Meek MM, et al. Malignancy is the most common cause of gastric outlet obstruction in the era of H2 blockers. Am J Gastroenterol. 1995;90:1769–70.PubMedGoogle Scholar
  13. 13.
    Poley JW, Steyerberg EW, Kuipers EJ, et al. Ingestion of acid and alkaline agents: outcome and prognostic value of early upper endoscopy. Gastrointest Endosc. 2004;60:372–7.CrossRefPubMedGoogle Scholar
  14. 14.
    Zargar SA, Kochhar R, Nagi B, et al. Ingestion of corrosive acids. Spectrum of injury to upper gastrointestinal tract and natural history. Gastroenterology. 1989;97:702–7.CrossRefPubMedGoogle Scholar
  15. 15.
    Boylan JJ, Gradzka MI. Long-term results of endoscopic balloon dilatation for gastric outlet obstruction. Dig Dis Sci. 1999;44:1883–6.CrossRefPubMedGoogle Scholar
  16. 16.
    Committee AT, Varadarajulu S, Banerjee S, et al. Enteral stents. Gastrointest Endosc. 2011;74:455–64.CrossRefGoogle Scholar
  17. 17.
    Repici A, Hassan C, Sharma P, et al. Systematic review: the role of self-expanding plastic stents for benign oesophageal strictures. Aliment Pharmacol Ther. 2010;31:1268–75.CrossRefPubMedGoogle Scholar
  18. 18.
    Eloubeidi MA, Lopes TL. Novel removable internally fully covered self-expanding metal esophageal stent: feasibility, technique of removal, and tissue response in humans. Am J Gastroenterol. 2009;104:1374–81.CrossRefPubMedGoogle Scholar
  19. 19.
    Buscaglia JM, Ho S, Sethi A, et al. Fully covered self-expandable metal stents for benign esophageal disease: a multicenter retrospective case series of 31 patients. Gastrointest Endosc. 2011;74:207–11.CrossRefPubMedGoogle Scholar
  20. 20.
    Senousy BE, Gupte AR, Draganov PV, et al. Fully covered Alimaxx esophageal metal stents in the endoscopic treatment of benign esophageal diseases. Dig Dis Sci. 2010;55:3399–403.CrossRefPubMedGoogle Scholar
  21. 21.
    Samanta J, Dhaka N, Sinha SK, et al. Endoscopic incisional therapy for benign esophageal strictures: technique and results. World J Gastrointest Endosc. 2015;7:1318–26.CrossRefPubMedPubMedCentralGoogle Scholar
  22. 22.
    Kochhar R, Makharia GK. Usefulness of intralesional triamcinolone in treatment of benign esophageal strictures. Gastrointest Endosc. 2002;56:829–34.CrossRefPubMedGoogle Scholar
  23. 23.
    Hirdes MM, van Hooft JE, Koornstra JJ, et al. Endoscopic corticosteroid injections do not reduce dysphagia after endoscopic dilation therapy in patients with benign esophagogastric anastomotic strictures. Clin Gastroenterol Hepatol. 2013;11(795–801):e1.Google Scholar

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© Springer International Publishing AG 2017

Authors and Affiliations

  1. 1.Division of Gastroenterology/HepatologyCenter for Advanced Therapeutic Endoscopy, University of Rochester Medical Center & Strong Memorial HospitalRochesterUSA

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