Endoscopic Approach to the Difficult to Manage Peptic Esophageal Stricture

The peptic esophageal stricture is a common structural cause of dysphagia, often linked to gastroesophageal reflux disease (GERD). Effective management is crucial to prevent complications such as malnutrition, aspiration and esophageal perforation. This article outlines a comprehensive approach to managing refractory peptic strictures, emphasizing tailored esophageal dilation strategies, adjunctive therapies such as intralesional corticosteroid or mitomycin C injections, and novel pharmacologic agents, specifically potassium-competitive acid blockers (PCABs). Additionally, advanced techniques like incisional therapy and stent placement are explored for complex cases. The ultimate goal is a personalized, patient-centered treatment plan that optimizes long-term outcomes and minimizes recurrence.