Esophageal Stricture in Esophageal Adenocarcinoma or Squamous Cell Carcinoma
Malignant esophageal stricture arising from esophageal cancer presents a distinct management challenge, with dysphagia relief as the primary clinical goal. The approach to this scenario is guided by the nature of the underlying malignancy and the patient's overall prognosis.
Clinical Scenario
This protocol addresses esophageal stricture caused by esophageal adenocarcinoma or squamous cell carcinoma — the most common causes of malignant strictures in the esophagus. Management priorities are palliative, focused on restoring swallowing function and enabling staging where appropriate.
Management Approach (Partial Overview)
Endoscopic stent placement is the preferred palliative intervention for dysphagia in this setting. Stent selection and whether to combine with additional modalities depends on clinical factors, including prognosis. The full protocol specifies indications, stent options, staging considerations, and sequencing.
Primary goal: Palliation of dysphagia.
Complete regimen details, selection criteria, and algorithm available via the protocol below.
References
DOI: 10.1016/j.giec.2025.02.002
- Esophageal adenocarcinoma and squamous cell carcinoma are the most common causes of malignant strictures in the esophagus.
- SEMS insertion alone is the preferred palliative management for dysphagia.
- Fully or partially covered stents are preferred over uncovered stents to prevent tumor ingrowth.
- Stenting can be combined with brachytherapy, particularly in those with a longer life expectancy, though this combination therapy is associated with more AEs, including fistula formation.
- Stepwise dilation to 14 mm is considered safe and effective in permitting echoendoscope passage beyond the stricture for staging purposes.
- Palliative dilations provide minimal long-term symptomatic relief, given progressive tumor growth.