Endoscopic management of benign esophageal strictures at a tertiary center in sub-Saharan Africa: a retrospective cohort study from Ethiopia

Benign esophageal stricture (BES) is a chronic complication of variable etiology, which is primarily managed by endoscopic interventions. Despite significant advances that have been made in therapeutic management across the world, literature on the demographic characteristics and clinical features of endoscopic management and its outcome of benign esophageal strictures is limited in the sub-Saharan Africa region. The study aimed to assess the clinical profile and endoscopic management outcomes of BES at a tertiary center in Ethiopia. A retrospective cohort study was conducted at Tikur Anbessa Specialized Hospital, Addis Ababa, Ethiopia. Medical records from 2018 to 2022, supplemented by structured patient interviews, were reviewed for all adult patients with endoscopy-confirmed benign esophageal strictures (BES). Technical success (surgical avoidance) and short-term complete clinical response were co-primary outcomes assessed over a 3-month follow-up period. Comparative analyses between caustic and non-caustic strictures and their clinical outcomes following endoscopic therapy were performed using chi-square and Fisher’s exact tests, with a p-value of < 0.05 considered statistically significant. Fifty-seven patients with benign esophageal strictures were included (caustic, n = 18; non-caustic, n = 39). Caustic injury was the most common etiology (31.6%), followed by peptic (19.3%) and postoperative strictures (17.5%); approximately one-third of patients met criteria for refractory strictures. Patients with caustic strictures were significantly younger and more likely to have proximal (38.9% vs. 15.4%), complex (66.7% vs. 12.8%), and multifocal strictures (61.1% vs. 2.6%) ( p < 0.001). A total of 333 endoscopic dilation sessions were performed with a median of 5 per patient (IQR = 2–10). The overall technical success (without subsequent surgical intervention) was achieved at 78.9% of cases. Among the 45 patients successfully managed exclusively with endoscopic dilation, complete clinical response at three months was achieved in 62.2% (28/45) without significant difference between caustic and non-caustic groups ( p = 0.738). Adjuvant intralesional steroid injection significantly improve a short term clinical outcomes (50% Vs 17.6%, X 2 = 4.71, p = 0.03). Perforation occurred in 3.5%, resulting in one procedure-related death. Endoscopic dilation is an effective treatment for benign esophageal strictures, achieved technical success in approximately four-fifths of patients. Among patients successfully managed without surgery, nearly two-thirds achieved complete clinical response within three months. A short-term clinical response has no significant difference between caustic and non-caustic cases. The use of adjuvant intralesional steroid injections significantly enhances clinical response. The escalation of endoscopic services in resource-limited settings could further optimize outcomes in the sub-Saharan Africa region while minimizing procedure-related complications.