Esophageal stricture

Last revised by Dr Mostafa El-Feky on 11 Aug 2022

Esophageal stricture refers to any persistent intrinsic narrowing of the esophagus

The term peptic stricture refers specifically to those benign esophageal strictures caused by chronic acid reflux, although some - incorrectly - use it more loosely to refer to any benign esophageal narrowing. The qualifying word "esophageal" is usually omitted as strictures due to acid elsewhere in the gut are very rare 5,6

Esophageal strictures are often associated with a hiatal hernia.

The most common causes are fibrosis induced by inflammatory and neoplastic processes. Because radiographic findings are not reliable in differentiating benign from malignant strictures, all should be evaluated endoscopically. 

These most commonly result from:

These are typically caused by gastro-esophageal reflux disease (GERD), either as a separate entity or in the setting of:

As stated earlier if reflux disease has been a significant contributor to the development of the stricture then using the term "peptic stricture" is appropriate.

Benign strictures characteristically:

  • smoothly tapering
  • typically concentric narrowing, but may affect only one side of the esophagus (asymmetric wall rigidity)

Malignant strictures are characteristically:

  • abrupt
  • asymmetric
  • eccentric with irregular, nodular mucosa

Tapered margins may occur with malignant lesions because of the ease of submucosal spread of a tumor.

The risk of Barrett esophagus in stricture is 20-40% and strictures should be evaluated endoscopically. 

Benign esophageal strictures are typically treated with dilation, providing symptomatic relief, however recurrent strictures do occur. Complex strictures (length >2 cm, tortuous) are more likely to be recurrent. Treatment of malignant strictures involves treating the underlying cause. In palliative strictures, stent placement and brachytherapy play a role 4.

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Cases and figures

  • Case 1: post corrosive stricture
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  • Case 2: malignant (proximal) & peptic (distal)
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  • Case 3: peptic stricture
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  • Case 4: secondary to correction atresia
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  • Case 5: ring-like peptic stricture
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  • Case 6: peptic stricture with hiatus hernia
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  • Case 7: peptic with a hiatus hernia
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  • Case 8: peptic stricture
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  • Case 9: peptic stricture
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  • Case 10: at proximal cervical esophagus
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  • Case 11: benign esophageal stricture
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  • Case 12: esophageal adenocarcinoma
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