Endoscopic management of patients with esophageal stricture in the oncology practice: A narrative review

Abstract

Esophageal strictures are generally classified into malignant due to advanced cancer and benign strictures after treatment for esophageal cancer. Several endoscopic procedures including ablation technique and stent placement, are used for patients with malignant esophageal strictures in our oncology practice. And, there is a potential for the development of severe esophageal stricture after curative treatment including esophagectomy, radiotherapy and endoscopic resection (ER), if the esophageal cancer can be cured. The aim of this narrative review article is to introduce landmark studies about endoscopic treatment or prevention esophageal stricture in oncology and to discuss about the unsolved issue or future direction. The primary endoscopic procedure for mechanically improving benign esophageal strictures is endoscopic balloon dilation (EBD), and incision treatment or stent placement is applied for refractory cases. Regarding ER for esophageal cancer, post-intervention stricture rates are approximately 15% and the risk of stricture is associated with the lesion’s size. Therefore, prophylactic treatments mainly steroid administration to prevent stricture after ER of early esophageal cancer was introduced and showed the favorable clinical outcome. Endoscopic intervention is effective and safety treatment to surgical treatment for patients with malignant and benign esophageal strictures. However, several unresolved issues remain in the endoscopic management of esophageal stricture and further development is necessary in our oncological practice.