Benign strictures of the esophagus usually result from scarring and subsequent tissue contraction secondary to esophageal wall injury. This pathology is caused in most cases by long-standing gastroesophageal reflux disease (GERD), often in association with one of the esophageal motility disorders (e.g., achalasia, diffuse esophageal spasm, or aperistalsis).1,2 Endoscopic dilation of benign esophageal strictures that are refractory to medical management is a less morbid alternative to surgery. Approximately 20% to 30% of cases are unrelated to GERD, and their treatment usually is more challenging. Examples include strictures arising from complications of surgical anastomosis,3 injuries caused by caustic ingestions, early and late consequences of external-beam radiation, esophageal sclerotherapy, laser or photodynamic therapy, medication- or pill-induced esophagitis that is associated with numerous medications (e.g., alendronate, ferrous sulfate, nonsteroidal anti-inflammatory drugs, phenytoin, potassium chloride, quinicline, tetracycline, and ascorbic acid) but most often aspirin, and rare dermatologic diseases, including epidermolysis bullosa dystrophica, among others.
Benign strictures also may result from external compression of the esophagus caused by mediastinal fibrosis induced by tuberculosis, fungal infection, radiation therapy, or idiopathic fibrosing mediastinitis. These conditions may give rise to long, narrow strictures that are difficult to dilate and in which dilation may be associated with a higher rate of complications.