What Should Be Done if Dilatations with Adjuncts Fail?

  • Ashraf Ibrahim
  • Talal Al-Malki


Conservative management is still preferable to esophageal replacement after failure of dilatation with adjuncts. There is no consensus about the definition of a refractory stricture or recurrent stricture. Before classifying a stricture as “refractory” it is important to assure that it was properly treated. Endoscopic electrocautery incisional therapy (EIT) and esophageal stenting may be successful. Removable covered stents allowed its use in children and expanded the indications for its usage to include a wide variety of congenital and acquired esophageal strictures. Contrary to other stents where food passes within the stent, the food in the customized dynamic stent passes between the stent and the esophageal wall allowing long term improvement of esophageal patency. The dynamic stents improve esophageal motility unlike the widespread self-expandable plastic or metallic esophageal stents. Stents are very effective for treating post-dilatation perforations and post-anastomotic leaks. Gagging, stent displacement, migration into the stomach, perforation, air way compression, granulation tissue, GERD, aspiration pneumonia, and arterioesophageal fistula are possible complications of stents.


Benign esophageal stricture Refractory stricture Recurrent stricture Esophageal stents 


  1. 1.
    Baird R, Laberge JM, Lévesque D. Anastomotic stricture after esophageal atresia repair: a critical review of recent literature. Eur J Pediatr Surg. 2013;23:204–13. Scholar
  2. 2.
    Okada A, Usui N, Inoue M, Kawahara H, Kawahara H, Kubota A, Imura K, et al. Esophageal atresia in Osaka: a review of 39 years’ experience. J Pediatr Surg. 1997;32(11):1570–4. Scholar
  3. 3.
    Tambucci R, Angelino G, De Angelis P, Torroni F, Caldaro T, Balassone V, et al. Anastomotic stricture after esophageal atresia repair: incidence, investigation, and management including treatment of refractory and recurrent stricture. Front Pediatr. 2017;5:120. Scholar
  4. 4.
    Dall’Oglio L, Caldaro T, Foschia F, Faraci S, Federrici di Abriola G, Rea F, et al. Endoscopic management of esophageal stenosis in children: new and traditional treatments. World J Gastrointest Endosc. 2016;8(4):212–9. Scholar
  5. 5.
    Spaander MC, Maron TH, Fuccio L, Schumacher Escorsell A, Escorsell A, Juan-Carlos Garcia-Pagán JC, et al. Esophageal stenting for benign and malignant disease: European Society of Gastrointestinal Endoscopy (ESGE) clinical guideline. Endoscopy. 2016;48:939–48. Scholar
  6. 6.
    ASGE Technology Committee, Tokar JL, Banerjee S, Barth BA, Desilets DJ, Kaul V, Kethi SR, et al. Drug-eluting/biodegradable stents. Gastrointest Endosc. 2011;74:954–8. Scholar
  7. 7.
    Foschia F, De Angelis P, Torroni F, Romeo E, Caldaro T, di Abriola GF, Pane A, et al. Custom dynamic stent for esophageal strictures in children. J Pediatr Surg. 2011;46(5):848–53. Scholar
  8. 8.
    Caldaro T, Torroni F, De Angelis P, Foschia F, Rea F, Romeo E, et al. Dynamic esophageal stents. Dis Esophagus. 2013;26:388–91. Scholar
  9. 9.
    Karamer RE, Quiros JA. Esophageal stents for severe strictures in young children: experience, benefits, and risk. Curr Gastroenterol Rep. 2010;12:203–10. Scholar
  10. 10.
    Repici A, Small AJ, Mendelson A, Jovani M, Correale L, Hassan C, et al. Natural history and management of refractory benign esophageal strictures. Endoscopy. 2016;84:222–8. Scholar
  11. 11.
    Walter D, Van den Berg MW, Hirdes MM. A randomized trial comparing biodegradable stent placement and endoscopic dilatation for recurrent benign esophageal strictures (Destiny study). United Eur Gastroenterol J. 2015;3(5 Suppl):A24.Google Scholar
  12. 12.
    Siersema PD. Treatment of refractory benign esophageal strictures: it is all about being “patient”. Gastrointest Endosc. 2016;84(2):229–31. Scholar
  13. 13.
    Liu D, Tan Y, Wang Y, Zhang J, Zhou J, Duan T, et al. Endoscopic incision with esophageal stent placement for the treatment of benign esophageal strictures. Gastrointest Endosc. 2015;81:1036–40. Scholar
  14. 14.
    Manfredi MA, Jennings RW, Anjum MW, Hamilton TE, Smithers CJ, Lightdale JR. Externally removable stents in the treatment of benign recalcitrant strictures and esophageal perforations in pediatric patients with esophageal atresia. Gastrointest Endosc. 2014;80:246–52. Scholar
  15. 15.
    Lange B, Kubia R, Wessel LM, Kahler G. Use of fully covered self-expandable metal stents for benign esophageal disorders in children. J Laparoendosc Adv Surg Tech A. 2015;25:335–41. Scholar
  16. 16.
    Ahmad A, Louis M, Song WK, Absah E. Esophageal stent placement as a therapeutic option for iatrogenic esophageal perforation in children. Avicenna J Med. 2016;6(2):51–3. Scholar
  17. 17.
    Rico FR, Panzer AM, Kooros K, Rossi TM, Pegoli W Jr. Use of polyflex airway stent in the treatment of perorated esophageal stricture in an infant: a case report. J Pediatr Surg. 2007;42(7):E5–8. Scholar
  18. 18.
    Rollins MD, Barnhart DC. Treatment of persistent esophageal leaks in children with removable, covered stents. J Pediatr Surg. 2012;47:1843–7. Scholar
  19. 19.
    Gebrail R, Absah E. Successful use of esophageal stent to treat a postoperative esophageal stricture in a toddler. ACG Case Rep J. 2014;2(1):61–3. Scholar
  20. 20.
    Lew RJ, Kochman ML. A review of endoscopic methods of esophageal dilatation. J Clin Gastroenterol. 2002;35:117–26. Scholar
  21. 21.
    Baumgart DC, Veltzke-Schlieker W, Wiedenmann B, Hintze RE. Successful recanalization of a completely obliterated esophageal stricture by using an endoscopic rendezvous maneuver. Gastrointest Endosc. 2005;61(3):473–5. Scholar
  22. 22.
    Dellon ES, Cullen NR, Madanick RD, Buckmire RA, Grimm IS, Weissler MC, et al. Outcomes of a combined antegrade and retrograde approach for dilatation of radiation-induced esophageal strictures (with video). Gastrointest Endosc. 2010;71(7):1122–9. Scholar
  23. 23.
    Groth SS, Odell DD, Luketich JD. Esophageal strictures refractory to endoscopic dilatation. In: Pawlik TM, et al., editors. Gastrointestinal surgery. New York, NY: Springer; 2015. p. 13–22. Scholar
  24. 24.
    Kochman ML, McClave SA, Boyce HW. The refractory and the recurrent esophageal stricture: a definition. Gastrointest Endosc. 2005;62(3):474–5. Scholar
  25. 25.
    Van Boeckel PGA, Siersema PD. Refractory esophageal strictures: what to do when dilatation fails. Curr Treat Options Gastroenterol. 2015;13:47–58. Scholar

Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  • Ashraf Ibrahim
    • 1
  • Talal Al-Malki
    • 2
  1. 1.Consultant Pediatric SurgeonArmed Forces Hospital, Southern Region, King Fahad Military HospitalKhamis MushaitSaudi Arabia
  2. 2.Senior Consultant Pediatric and Neonatal SurgeonAlhada Military Hospital, Vice President for D&Q, Taif UniversityTaifSaudi Arabia

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