**4. Conclusion**

For endoscopic dilatation, the balloon is positioned across the gastro-esophageal junction and inflated to the smallest diameter. The endoscopist grasps the catheter to assess the tension during pull through and then slowly withdraws the endoscope to the proximal esophagus. The procedure is repeated using a sequentially larger diameter balloon until adequate dilation

Several sessions of bougie dilation may be necessary for adequate treatment for radiationinduced strictures because most strictures are complex. The ASGE report summarizes a combined antegrade–retrograde rendezvous approach described in case reports and case series for the management of severe radiation-induced strictures with complete occlusion of the proximal esophagus. After dilation, the endoscopist performing this technique passes a standard endoscope or small-caliber endoscope through the stomach into the esophagus via

Esophageal dilation for achalasia involves forceful disruption of the lower esophageal sphincter. This is usually accomplished with 30- to 40-mm-diameter pneumatic balloon dilators. Dilation is generally performed over a wire under fluoroscopic guidance, although nonfluoroscopically guided dilation using endoscopic visualization alone has been reported.

POEM is a new endoscopic procedure used for the treatment of achalasia [29]. This novel endoscopic esophagomyotomy method was first reported by Pasricha et al. in porcine models and then by Inoue et al. in humans. POEM is performed by dissection and division of the inner circular muscle layer of the esophagus through a submucosal tunnel created endoscopically by a small proximal opening of the esophageal mucosa. A study evaluating the role of POEM

A further option is endoscopic botulinum toxin injection into the lower esophageal sphincter.

Ham et al. identified the currently available biodegradable stents for benign esophageal

Anastomotic strictures have been reported in 9–48% of patients after esophagectomy for esophageal cancer. The strictures are diagnosed in patients with dysphagia in whom a standard flexible esophagoscope cannot be passed across the anastomosis. Both bougie and balloon dilation have been used for the treatment of anastomotic strictures with success rates of up to 93%. In Figure 4A,B showed the typical anastomotic stricture and endoscopic balloon dilation for it. There is a high recurrence rate, however, and patients often require frequent

strictures [30]. This technique will also be available for the treatment of achalasia.

reported a significant improvement in dysphagia scores.

This technique offers good short-term results.

**3.8. Postesophagectomy anastomotic strictures**

is achieved [3,14].

100 Seminars in Dysphagia

**3.7. Achalasia**

sessions.

**3.6. Postradiation stricture**

an existing gastrostromy tract.

This chapter is based on the ASGE guidelines and recommendations by AGA. Endoscopy is more sensitive than radiology for identifying subtle mucosal lesions of the esophagus such as mild esophagitis caused by gastroesophageal reflux or infection. A cost analysis also showed that EGD with therapeutic intent is more cost effective than an initial diagnostic approach with barium swallow in patients with histories suggestive of benign or malignant esophageal obstruction.

Various endoscopic treatments are useful for diseases with dysphagia and minimally invasive compared to surgical procedures.
