ABSTRACT
It is useful to consider strictures in terms of complexity. Simple strictures are short and straight while complex ones are tight, long, and irregular. The majority of strictures are amenable to dilatation using one or more of the methods described below. However, recent perforation is a contraindication. The key goals of intervention are the relief of dysphagia, oral nutrition, and airway protection. At the commencement of intervention, an estimate of the number of dilatations likely to result in cure is helpful. This helps to avoid children having large numbers of dilatations without commensurate clinical benefit. Those with complex esophageal strictures and, in particular, the recalcitrant ones who have undergone numerous dilatations with little improvement in dysphagia and limited oral nutritional intake, are best managed in the context of a multidisciplinary team, including surgeon with esophageal replacement expertise, gastroenterologist, interventional radiologist, and dietician. When the multidisciplinary expertise is not locally available, referral to an appropriate center is advisable for complex and recalcitrant strictures.
