Pediatric benign esophageal strictures: current understanding from etiology to treatment

Esophageal strictures (ES) are a significant clinical concern in pediatric esophageal diseases and substantially affect patients' quality of life. The causes can be classified as congenital, secondary, and dyskinetic types. While most ES cases are benign, clinical outcomes vary widely by etiology, necessitating personalized therapeutic strategies. Current approaches predominantly involve minimally invasive endoscopic interventions, including balloon or bougie dilation, stent placement, incisional therapy, and intralesional steroid injection. Refractory cases may require combining or alternating multimodal therapies or surgical intervention, warranting further attention from clinicians. Despite varying causes of ES, conservative management is generally preferred over surgery in children. Endoscopic dilation, using bougie or balloons, is the most frequently employed technique, with comparable safety and efficacy. For recurrent or refractory ES, commonly arising from caustic ingestion, surgical anastomosis, congenital malformations, or radiation-induced strictures, adjunctive options include intralesional drug injection, stent placement, and endoscopic incisional therapy. They remain a challenge for many endoscopists. This review summarizes advances in pediatric ES management. While endoscopic treatment in complex and refractory strictures remains challenging, comparison across relevant studies is limited by inconsistent definitions of endoscopic or clinical success metrics. Novel methods have been developed to optimize treatment for refractory strictures. However, further studies in pediatric populations are necessary to validate their efficacy as adjuncts to endoscopic dilation.