Surgical management of esophageal strictures.

Benign esophageal strictures may be caused by numerous disorders, but more than 90% of them are due to severe gastroesophageal reflux or ingestion of lye. A new classification of the severity of the stricture is proposed, based on the endoscopic and radiological evaluation of three parameters: internal diameter, length of the stricture and ease or difficulty of dilatation. In patients with strictures secondary to reflux, initial treatment includes periodic dilatation. Grade I and II strictures require esophageal resection. In grade III patients, bile diversion or esophageal resection should be performed. Caustic ingestion produces a wide spectrum of tissue damage in the upper digestive tract ranging from minimal chemical burn to an extensive and massive necrotic lesion. The basic and main treatment in patients with an established esophageal stricture is periodic dilatation avoiding, if at all possible, any kind of surgery. In patients with grade III stricture, colonic interposition between cervical esophagus and stomach or duodenum is preferred, treating the damaged esophagus by resection or leaving it "in situ". Psychiatric evaluation is mandatory in these cases.