Endoscopic Management of Gastrointestinal Strictures: Current Techniques and Future Perspectives

Stephane Guinot^*
*Correspondence: Stephane Guinot, Department of Gastroenterology and Hepatology, University of São Paulo, Butantã, São Paulo, Brazil, Email:

Introduction

Gastrointestinal strictures pose a significant clinical challenge, often requiring intervention to relieve symptoms and improve patient outcomes. Endoscopic management has emerged as a cornerstone in the treatment of gastrointestinal strictures, offering minimally invasive approaches with promising outcomes. This review aims to provide an overview of current endoscopic techniques for managing gastrointestinal strictures across different anatomical sites, including esophageal, gastric, and colonic strictures. Additionally, it discusses emerging technologies and future perspectives in the field, emphasizing the potential for further advancements to enhance therapeutic efficacy and patient care.

Gastrointestinal strictures, characterized by narrowing of the luminal diameter, can occur at various sites along the gastrointestinal tract, including the esophagus, stomach, and colon. They can result from a multitude of etiologies, such as inflammatory conditions, benign and malignant tumors, prior surgeries, or radiation therapy. Clinical manifestations of strictures include dysphagia, odynophagia, regurgitation, abdominal pain, bloating, and altered bowel habits, significantly impairing patients' quality of life [1-3].

Endoscopic management has evolved as a vital component in the treatment armamentarium for gastrointestinal strictures. Compared to traditional surgical approaches, endoscopic techniques offer several advantages, including reduced invasiveness, shorter hospital stays, and fewer complications. This review provides an update on current endoscopic strategies for managing gastrointestinal strictures and explores the potential of emerging technologies to further improve patient outcomes.

Description

Esophageal strictures commonly arise from gastroesophageal reflux diseas, esophageal malignancies, esophageal strictures associated with eosinophilic esophagitis, or prior interventions such as esophageal surgery or radiation therapy. Endoscopic modalities for managing esophageal strictures include balloon dilation, stent placement, and various incisional therapies. Balloon dilation is a widely used technique for the treatment of benign and malignant esophageal strictures. It involves the passage of an inflatable balloon through the stricture under endoscopic guidance, followed by controlled inflation to disrupt the fibrotic tissue and widen the lumen. In cases of refractory or recurrent strictures, temporary or permanent stent placement may be considered to maintain luminal patency.

Endoscopic incisional therapy, such as through-the-scope incision or endoscopic submucosal dissection, allows precise incision and removal of fibrotic tissue contributing to the stricture formation. These techniques are particularly valuable in managing refractory strictures or those associated with EoE. Gastric strictures can occur secondary to peptic ulcer disease, malignancies, prior surgeries, or inflammatory conditions such as Crohn's disease. Endoscopic dilation with balloons or bougies is the primary approach for managing gastric strictures. Endoscopic balloon dilation involves the passage of a balloon dilator through the stricture under endoscopic guidance, followed by controlled inflation to disrupt the fibrotic tissue [4,5]. Bougie dilation utilizes a weighted dilator passed through the stricture to gradually dilate the narrowed segment. In cases of malignant gastric strictures, self-expandable metallic stents may be deployed endoscopically to alleviate obstruction and improve oral intake. SEMS placement offers effective palliation, especially in patients with unresectable tumors or those unfit for surgery.

Colonic strictures commonly arise from inflammatory bowel disease, colorectal cancer, diverticular disease, or post-inflammatory scarring. Endoscopic management of colonic strictures includes balloon dilation and stent placement. Balloon dilation of colonic strictures is performed using similar techniques as in the esophagus and stomach, with controlled inflation to achieve luminal expansion. This approach is effective in relieving obstructive symptoms and avoiding the need for surgical intervention in many cases. For malignant colonic strictures, SEMS placement provides effective palliation, allowing restoration of bowel continuity and improvement in quality of life. In cases of benign strictures, such as those associated with Crohn's disease, biodegradable stents may offer a temporary solution to avoid long-term stent-related complications.

The field of endoscopic management of gastrointestinal strictures continues to evolve with ongoing advancements in technology and techniques. Future perspectives include the development of novel stent designs with improved biocompatibility and durability, targeted drug delivery systems integrated into stents to address underlying inflammatory conditions, and the use of advanced endoscopic imaging modalities for real-time assessment and guidance during interventions. Furthermore, the advent of endoscopic suturing systems holds promise for the treatment of refractory strictures, enabling tissue approximation and closure of defects. Additionally, tissue-engineered constructs and regenerative therapies may offer long-term solutions for strictures by promoting tissue regeneration and remodeling.

Integration of artificial intelligence and machine learning algorithms into endoscopic practice may enhance diagnostic accuracy, predict treatment outcomes, and facilitate personalized therapeutic approaches. Moreover, the development of endoscopic robotic systems may enable more precise and dexterous interventions, particularly in challenging anatomical locations.

Conclusion

In conclusion, endoscopic management plays a central role in the treatment of gastrointestinal strictures, offering minimally invasive approaches with favorable outcomes. Continued innovation and research efforts hold promise for further improving therapeutic efficacy, reducing complications, and enhancing patient care in the future.

References

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