If an esophageal stricture develops, what is the first-line treatment?

The first-line treatment for an esophageal stricture is dilation with a Maloney dilator or balloon catheter. This approach is generally preferred because it is a less invasive, effective method for relieving the constriction in the esophagus. Dilation works by mechanically widening the narrowed area, allowing for improved passage of food and liquids.

In cases of esophageal strictures, there are several underlying causes, such as benign strictures from inflammation, scarring, or gastroesophageal reflux disease (GERD). Dilation is often successful in these cases, especially when the stricture is non-malignant. The procedure can frequently be performed on an outpatient basis, reducing complications and recovery time.

Other treatments, while they may be appropriate in specific contexts, do not serve as initial interventions. For instance, esophagectomy, while a definitive treatment for severe cases or malignancies, is usually reserved for advanced disease when dilation and other conservative measures are insufficient. Medication therapy might be suitable for managing underlying conditions, such as GERD, but it does not address the stricture directly. Similarly, feeding tube placement is more of a temporary solution aimed at nutritional support when safe swallowing is compromised but does not treat the stricture itself.

In summary, dilation with