Benign Pharyngoesophageal Strictures: Increasingly Encountered and Still a Challenge

Benign pharyngoesophageal stricture (PES) is one of the most frequent post-treatment morbidities in head and neck cancer patients [1]. In fact, the successive interventions and longer patients’ survival increased the risk of related complications. PES is mostly associated with radiation therapy in a dose-dependent manner and enhanced by combined chemotherapy or surgery [1, 2]. Endoscopic dilation with bougies or balloons is the standard treatment in such strictures, with a considerably effective technical success rate and an acceptable safety profile. Nevertheless, improvement is often transient, requiring recurrent interventions [3]. The goals of therapy are the relief of dysphagia, with the avoidance of complications and the prevention of recurrence. Still, there is no universal definition of therapeutic efficacy. Objective assessment of functional outcomes is less consistent due to significant heterogeneity in the literature [4]; therefore, technical success is most frequently addressed. Kochman et al. [3] previously defined recurrent and refractory esophageal stricture, which are also commonly used as outcome measures. In this issue of GE – Portuguese Journal of Gastroenterology, Martins et al. [5] report a 3-year experience of treating pharyngoesophageal strictures at a tertiary oncologic center. The overall long-term efficacy of endoscopic dilation program on radiotherapy and anastomotic PES was evaluated. Forty-eight patients included in this study underwent a total of 296 dilations. The preferential dilation technique consisted in Savary bougies dilation done via traditional anterograde access, with a median of 4 dila-