title: Multi-disciplinary approach for management of refractory benign occlusive esophageal strictures.
abstract: BACKGROUND
  Benign occlusive esophageal strictures create substantial morbidity and have poor surgical outcomes. Various endoscopic techniques have been described to manage these strictures. The challenge remains to maintain adequate long-term esophageal patency and to limit the need for serial endoscopic dilations. Little has been reported regarding the management of these benign occlusive strictures.
  
  
  METHODS
  We report a case series describing the management of technically challenging benign occlusive esophageal strictures. Three patients with occlusive esophageal strictures of differing etiologies were treated using a variety of endoscopic methodologies.
  
  
  RESULTS
  The first patient sustained a caustic oropharyngeal injury resulting in a proximal esophageal stricture which was treated by using a combined antegrade retrograde dilation (CARD) with argon plasma coagulation (APC) and needle knife dissection resulting in the successful recanalization and patency of his stricture. A second patient developed an esophageal stricture following radiotherapy, and was treated with a CARD procedure and serial balloon dilations in combination with APC to successfully achieve esophageal luminal patency. The final patient acquired an occlusive esophageal stricture after treatment for thyroid cancer which was treated with endoscopic needle knife dissection followed by serial balloon dilations to successfully manage this stricture.
  
  
  CONCLUSIONS
  Occlusive esophageal strictures pose a difficult challenge to gastroenterologists and little has been reported with regards to their endoscopic management. Using the CARD technique, needle knife dissection and APC, individually or in combination, luminal patency of occlusive esophageal strictures can be accomplished safely with good results.
authors.affiliation: The Brooklyn Hospital Center, New York Presbyterian Healthcare System, 121 Dekalb Ave, Brooklyn NY, 11105, USA.
authors.forename: Shashideep
authors.initials: S
authors.lastname: Singhal
authors.forename: Syed S
authors.initials: SS
authors.lastname: Hasan
authors.forename: Dan C
authors.initials: DC
authors.lastname: Cohen
authors.forename: Timothy
authors.initials: T
authors.lastname: Pfanner
authors.forename: Scott
authors.initials: S
authors.lastname: Reznik
authors.forename: Sushil
authors.initials: S
authors.lastname: Duddempudi
keywords: CARD; combined antegrade retrograde dilation; dilation; esophageal stricture; management; needle knife dissection; occlusive; refractory