Esophageal Stricture
ICD-10 K22.2 · ICD-11 DA20.0.2

Peptic Esophageal Stricture with Gastroesophageal Reflux Disease When Endoscopic Dilation Did Not Resolve Dysphagia

This protocol addresses patients with a peptic stricture located in the distal third of the esophagus in the setting of gastroesophageal reflux disease (GERD). GERD-driven chronic inflammation, ulceration, and fibrosis of the distal esophagus underlies the development of these peptic strictures; their presence is itself conclusive evidence of GERD.

Previous treatment — did not achieve goals

Initial management with endoscopic balloon or bougie dilation combined with indefinite acid suppressive therapy was the first-line approach. When the stricture and dysphagia have not resolved — typically defined as requiring more than the expected number of dilation sessions — the stricture is considered refractory and this next-step protocol applies.

Next-line approach (partial overview)

For refractory peptic strictures, the structured protocol involves an intralesional intervention applied to the stricture before dilation, or an alternative luminal approach — details of the full sequence, technique, and preparation are in the complete regimen.

Full dosing, technique, and step-by-step algorithm available via the link below.

Instant Access to Structured Evidence-Based Regimens

References

Gastroesophageal reflux disease (GERD) can cause inflammation, ulceration, and fibrosis of the distal esophagus, leading to the development of peptic strictures. Peptic strictures are conclusive evidence for a diagnosis of GERD.

For refractory peptic strictures, triamcinolone injection into the stricture prior to dilation or stent placement can reduce the risk of stricture recurrence. In a controlled trial of 30 patients with a recurrent peptic esophageal stricture, patients were randomized to receive either steroid injection (40 mg triamcinolone injected in four 1 mL aliquots of saline solution) or sham injection into the stricture followed by balloon dilation of the stricture.

DOI: 10.1016/j.giec.2025.02.002

View source ↗