Esophageal Stricture

Esophageal stricture represents a challenging condition in equine medicine characterized by abnormal narrowing of the esophageal lumen that impairs normal passage of feed material from the mouth to the stomach. This narrowing typically results from scar tissue formation following esophageal injury, though other causes including external compression, inflammation, and congenital abnormalities occasionally contribute. The restricted esophageal diameter prevents normal-sized feed boluses from passing, leading to recurrent obstruction episodes, regurgitation, and progressive nutritional compromise. Understanding esophageal stricture is essential for managing affected horses and preventing the serious complications that arise from repeated choke episodes.

Esophageal stricture affects horses across all breeds and ages, though the condition most commonly develops as a complication of prior esophageal trauma or disease. Horses with history of severe or prolonged choke episodes face elevated stricture risk due to pressure-induced tissue damage during obstruction. Previous esophageal surgery, including procedures to remove foreign bodies or correct other abnormalities, may result in scar formation at surgical sites. Chemical injury from caustic substances or medications lodged in the esophagus can cause severe mucosal damage leading to stricture development. Foals may develop strictures following esophageal trauma during nasogastric tube passage or from congenital abnormalities present at birth.

The impact of esophageal stricture on equine health extends beyond the immediate swallowing difficulties to encompass nutritional decline, aspiration pneumonia risk, and significant quality of life concerns. Affected horses cannot consume adequate nutrition when strictures prevent normal feed passage, leading to progressive weight loss and poor body condition. Each obstruction episode creates aspiration risk and potential respiratory complications. The chronic nature of strictures requires ongoing management that significantly affects daily care routines. Some horses with severe strictures face limited treatment options and may be unable to maintain acceptable quality of life.

Treatment outcomes for esophageal stricture vary considerably depending on stricture location, severity, extent, and response to intervention. Some strictures respond well to dilation procedures that mechanically expand the narrowed segment, potentially allowing return to normal or near-normal function. Others prove refractory to treatment, requiring permanent dietary modifications or multiple intervention procedures. Surgical options exist for select cases but carry significant risks and variable success rates. Early recognition of developing stricture following esophageal injury provides the best opportunity for intervention before extensive scar maturation occurs, emphasizing the importance of vigilant monitoring following any esophageal trauma.

The primary causes of esophageal stricture involve tissue injury followed by excessive scar tissue formation during the healing process. Choke episodes represent the most common precipitating event, with prolonged obstruction causing pressure necrosis of esophageal wall tissues. The body's healing response replaces damaged tissue with fibrous scar tissue that contracts over time, progressively narrowing the esophageal lumen at the injury site. Severe or repeated choke episodes at the same location dramatically increase stricture risk compared to single, brief obstructions. The degree of initial tissue damage directly correlates with subsequent stricture severity and treatment responsiveness.

While esophageal stricture itself is not considered hereditary, certain factors potentially predisposing to esophageal injury may have genetic components within some horse populations. Conformational characteristics affecting esophageal anatomy or swallowing mechanics could theoretically run in family lines, though no specific genetic associations have been documented. Some horses appear to have inherently more robust healing responses that produce excessive scar formation following any injury. Developmental abnormalities of the esophagus may occasionally have hereditary components, though most congenital esophageal conditions occur sporadically without clear inheritance patterns.

Environmental and management factors contribute to stricture development primarily through their role in causing initial esophageal injury. Feeding practices that increase choke risk indirectly elevate stricture risk when obstructions occur. Nasogastric tube passage, though a routine procedure, occasionally causes esophageal trauma that may result in stricture formation. Chemical injury from medications including some nonsteroidal anti-inflammatory drugs when administered orally or from caustic substances accidentally ingested can cause severe mucosal damage. External trauma from kicks, falls, or other accidents may injure the esophagus through compression or direct penetrating wounds. Foreign body ingestion creates both immediate obstruction and potential for ongoing tissue damage.

Risk factors compounding stricture likelihood following esophageal injury include prolonged obstruction duration, delayed treatment, concurrent conditions, and individual healing characteristics. Choke episodes lasting several hours cause more extensive tissue damage than those resolving quickly. Horses with compromised immune function or poor nutritional status may experience impaired healing with excessive scarring. Previous stricture at the same location indicates scarring tendency and increases likelihood of recurrence following any additional injury. Certain medications or concurrent diseases affecting tissue healing may predispose to abnormal scar formation. Age-related changes in tissue healing characteristics may influence stricture development and treatment response.

The pathophysiology of esophageal stricture involves complex wound healing processes that produce excessive fibrous tissue replacement of normal esophageal wall structures. Initial injury causes mucosal damage and potentially deeper tissue destruction depending on severity. The inflammatory response that follows recruits fibroblasts and other cells responsible for tissue repair. In normal healing, appropriate collagen deposition restores tissue integrity while maintaining functional characteristics. In stricture formation, excessive collagen production and abnormal organization create dense scar tissue that lacks the elasticity of normal esophageal wall. Progressive contraction of this scar tissue over weeks to months narrows the lumen incrementally. Mature strictures become increasingly dense and rigid, potentially becoming refractory to dilation procedures as collagen cross-linking stabilizes the scar architecture.

Early warning signs of developing esophageal stricture often appear during the weeks following esophageal injury as scar tissue forms and matures. Horses may display subtle changes in eating behavior including slowed consumption, increased chewing time, or apparent discomfort during swallowing. Small amounts of feed material or saliva may occasionally appear at the nostrils during eating before frank regurgitation develops. Changes in feed preferences toward softer, wetter feeds that pass the narrowing area more easily may indicate developing restriction. Weight loss may begin before obvious swallowing difficulties become apparent as horses unconsciously reduce intake to avoid discomfort. Handlers familiar with individual horses' normal eating patterns are best positioned to recognize these early departures from baseline.

Common symptoms of established esophageal stricture reflect the mechanical obstruction to normal feed passage. Recurrent choke episodes represent the hallmark presentation, with affected horses experiencing repeated obstructions at the stricture site. Regurgitation of feed material and saliva from the nostrils occurs during eating as material accumulates above the narrowed segment. Difficulty swallowing, termed dysphagia, manifests as multiple swallowing attempts required to pass each bolus. Excessive salivation or drooling during eating reflects impaired clearance of oral secretions. Extended meal times become necessary as horses work to pass small amounts of feed through the restricted passage.

Behavioral changes accompanying esophageal stricture demonstrate the animal's adaptation to eating difficulties and associated discomfort. Affected horses often develop strong feed preferences, selecting softer feeds and rejecting coarse hay that proves difficult to swallow. Some horses eat with their heads elevated or adopt unusual postures attempting to facilitate feed passage. Decreased appetite may develop as horses associate eating with discomfort, leading to voluntary intake reduction. Anxiety during feeding time reflects anticipation of difficulty or previous choking episodes. Depression and social withdrawal may develop in horses experiencing chronic nutritional deficiency from inadequate intake.

Physical signs detectable upon examination provide diagnostic information regarding stricture presence and severity. Progressive weight loss despite apparently adequate feed provision suggests inability to consume sufficient nutrition. Poor body condition with prominent skeletal structures indicates chronic caloric deficit. Palpation of the esophagus in the cervical region may occasionally identify thickened, scarred tissue at the stricture site, though many strictures occur in locations inaccessible to external palpation. Evidence of aspiration pneumonia including elevated respiratory rate, cough, and fever may indicate complications from repeated regurgitation. Dehydration may develop in horses limiting water intake along with feed.

Symptom progression in untreated esophageal stricture typically follows a pattern of worsening over weeks to months as scar tissue matures and contracts. Initial mild slowing of feed consumption progresses to obvious dysphagia and intermittent regurgitation. Choke episodes become more frequent and may occur with progressively smaller feed particles as the stricture narrows further. Weight loss accelerates as nutritional intake becomes increasingly compromised. Aspiration pneumonia risk increases with each regurgitation episode as more material enters the airway. Without intervention, severely affected horses may become unable to maintain adequate nutrition through oral feeding.

Emergency symptoms requiring immediate veterinary care include acute choke episodes superimposed on underlying stricture disease and signs of aspiration complications. Any complete esophageal obstruction requires treatment regardless of known stricture presence. Respiratory distress including labored breathing, cough, and nasal discharge suggest aspiration pneumonia requiring antibiotic therapy. Rapid weight loss or inability to maintain hydration indicates nutritional crisis. Complete refusal to eat or drink warrants emergency evaluation for complete obstruction or severe esophageal pain. Fever developing in a horse with known stricture suggests infection requiring prompt assessment and treatment.

Physical examination provides initial assessment information but rarely definitively diagnoses esophageal stricture without additional testing. History of previous esophageal trauma or choke episodes in a horse presenting with recurrent obstruction strongly suggests stricture development. Observation during feeding may reveal dysphagia, excessive chewing, and regurgitation characteristic of esophageal narrowing. External palpation occasionally identifies thickened esophageal tissue in the cervical region when strictures occur at accessible locations. Assessment of body condition and nutritional status documents the impact of impaired feeding ability. Vital parameter evaluation identifies any concurrent complications including aspiration pneumonia.

Diagnostic testing confirms stricture presence and characterizes location, extent, and severity to guide treatment planning. Nasogastric tube passage encounters resistance at the stricture site, though careful technique is essential to avoid causing additional trauma. Contrast radiography using barium or other agents outlines the esophageal lumen, clearly demonstrating the narrowed segment when images are obtained during contrast passage. This modality provides information about stricture length and degree of narrowing that influences treatment approach selection. Thoracic radiographs evaluate for aspiration pneumonia evidence in horses with respiratory signs.

Advanced diagnostic modalities provide detailed characterization essential for treatment planning in complex cases. Esophageal endoscopy allows direct visualization of the stricture, enabling assessment of mucosal appearance, lumen diameter, and location relative to anatomical landmarks. Multiple views and gentle probe passage provide information about stricture length and tissue characteristics. Endoscopy also identifies concurrent abnormalities including ulceration, diverticula, or additional strictures that might affect management. Transesophageal ultrasound, when available, may characterize esophageal wall thickness and surrounding tissue involvement. Fluoroscopic examination enables real-time observation of contrast passage, providing dynamic information about stricture function and compliance.

Differential diagnosis for esophageal stricture includes other causes of recurrent dysphagia and esophageal obstruction. Megaesophagus produces similar swallowing difficulties but involves dilation rather than narrowing, with distinct endoscopic and radiographic appearances. Esophageal diverticulum creates an outpouching that may trap feed material, causing symptoms resembling stricture. External compression from masses, abscesses, or enlarged lymph nodes can narrow the esophageal lumen without intrinsic wall abnormalities. Esophageal tumors, though rare in horses, may cause progressive obstruction. Neuromuscular disorders affecting esophageal motility produce dysphagia without anatomical narrowing. Persistent choke without stricture may occur in horses with severe dental disease or other factors promoting repeated obstruction.

Emergency and immediate treatment of acute obstruction episodes complicating esophageal stricture follows standard choke management protocols while considering the underlying structural abnormality. Sedation and muscle relaxation facilitate obstruction relief and reduce patient stress. Nasogastric lavage carefully performed minimizes additional trauma to already scarred tissue. Particular caution is warranted given the compromised tissue integrity at stricture sites, where aggressive manipulation risks perforation. Immediate treatment goals focus on relieving the acute obstruction while planning definitive stricture management to reduce recurrence frequency.

Medical management of esophageal stricture encompasses dietary modifications, anti-inflammatory therapy, and supportive care measures. Dietary adjustments form the cornerstone of conservative management, with affected horses transitioned to feeds that pass more easily through narrowed segments. Slurried or pelleted feeds moistened to gruel consistency often pass strictures that would obstruct with normal-textured feeds. Frequent small meals reduce bolus size attempting to pass the restriction. Anti-inflammatory medications including corticosteroids may help reduce ongoing inflammation contributing to stricture progression, though evidence supporting their efficacy in mature strictures remains limited. Gastroprotectants protect stomach lining during periods of altered feeding.

Interventional procedures, particularly balloon dilation, represent the primary definitive treatment approach for esophageal stricture in horses. Balloon dilation involves positioning an inflatable balloon catheter at the stricture site and gradually inflating it to mechanically stretch the narrowed segment. Multiple dilation sessions spaced over weeks are typically necessary, as strictures tend to recontract following single procedures. Success rates vary considerably depending on stricture characteristics, with shorter, less mature strictures generally responding better than extensive, dense scar formations. Bougienage, using progressively larger dilators passed through the stricture, provides an alternative mechanical dilation approach. Intralesional corticosteroid injection following dilation may help reduce scar reformation, though evidence remains limited.

Surgical intervention becomes necessary for strictures refractory to dilation or those with characteristics precluding less invasive approaches. Esophageal resection with anastomosis removes the strictured segment and reconnects the healthy esophagus above and below. This technically demanding procedure carries significant risks including anastomotic dehiscence and recurrent stricture formation at the surgery site. Esophagomyotomy, incising the esophageal muscle layer, may relieve stricture when muscular spasm contributes to narrowing. Patch grafting techniques have been described for extensive strictures not amenable to resection. Surgical decisions carefully weigh stricture characteristics, available expertise, and likely outcomes against continued medical management or humane euthanasia in refractory cases.

Supportive care throughout stricture management addresses nutritional needs and complication prevention. Ensuring adequate caloric intake despite swallowing limitations may require creative feeding approaches or temporary alternative nutrition routes. Monitoring body condition and weight provides objective assessment of nutritional adequacy. Promptly treating any aspiration pneumonia episodes protects respiratory function and overall health. Managing concurrent conditions that might affect healing or treatment response optimizes outcomes. Psychological support for handlers facing difficult long-term management decisions acknowledges the emotional challenges of caring for chronically affected horses.

Treatment decision factors influencing management approach selection include stricture characteristics, horse use and value, owner resources, and quality of life considerations. Short, single strictures in accessible locations with compliant tissue represent the best candidates for successful dilation. Extensive, multiple, or densely scarred strictures carry poor prognosis regardless of treatment intensity. Performance expectations affect acceptable outcome definitions, as horses required to consume large volumes may need more complete resolution than pleasure animals maintained on modified diets. Financial considerations influence treatment intensity given the multiple procedures often necessary. Quality of life assessment guides decisions about continuing treatment versus humane euthanasia when horses cannot maintain adequate condition despite intervention.

Recovery timeline for esophageal stricture varies tremendously based on stricture characteristics and treatment approach, ranging from weeks for simple cases responding to dilation to indefinite ongoing management for refractory strictures. Single balloon dilation procedures show initial results within days, though stricture recontraction over subsequent weeks typically necessitates repeated sessions. A series of three to six dilation procedures spaced at two to four week intervals may be required before stable improvement occurs. Surgical recovery following esophageal resection requires eight to twelve weeks of restricted activity and careful dietary management before return to normal feeding attempts. Some horses with severe strictures never achieve full recovery, requiring permanent dietary modifications.

Post-treatment care and monitoring focus on maintaining nutritional status while assessing treatment response and watching for complications. Following dilation procedures, careful graduated dietary reintroduction tests the durability of luminal expansion. Initial feeding of slurried feeds progresses cautiously to thicker consistencies and eventually normal textures if tolerated. Observation during feeding identifies early signs of redeveloping restriction before frank obstruction occurs. Regular weight and body condition monitoring provides objective recovery assessment. Scheduling follow-up endoscopy at appropriate intervals allows direct visualization of treatment effects and early detection of restructuring.

Prognosis factors affecting outcomes include stricture length, location, tissue characteristics, and response to initial treatment. Short strictures less than five centimeters in length respond significantly better to dilation than extensive lesions. Cervical strictures in accessible locations are more amenable to surgical approaches if needed compared to thoracic strictures. Fresh, immature strictures with softer tissue prove more responsive to dilation than densely scarred, mature lesions. Horses showing substantial improvement after initial dilation carry better prognoses than those with minimal response despite adequate technique. Absence of concurrent esophageal abnormalities improves outlook compared to cases with multiple strictures or megaesophagus.

Long-term outlook for horses with esophageal stricture depends heavily on achieving stable luminal diameter adequate for necessary nutritional intake. Horses achieving good dilation results may return to near-normal function with minimal ongoing management modifications. Those with partial improvement may maintain acceptable quality of life on permanently modified diets emphasizing soft, easily swallowed feeds. Horses with refractory strictures face challenging decisions regarding intensive ongoing management versus quality of life considerations. Some individuals maintain satisfactory condition for years with careful management despite persistent strictures. Others deteriorate despite intervention, ultimately requiring humane euthanasia when quality of life becomes unacceptable.

Management practices preventing esophageal stricture focus primarily on avoiding the esophageal injuries that precipitate scar formation. Implementing comprehensive choke prevention strategies reduces the most common precipitating events. Prompt, appropriate treatment of any choke episode minimizes tissue damage and subsequent scarring risk. Careful nasogastric tube passage technique prevents iatrogenic esophageal trauma during routine procedures. Avoiding administration of potentially caustic oral medications without appropriate dilution or protective measures reduces chemical injury risk. Proper feed storage and quality control prevents access to foreign materials or spoiled feeds that might cause obstruction or irritation.

Nutritional prevention strategies address feeding practices that increase choke and subsequent stricture risk. Ensuring all feeds are appropriate for individual horses' dental status and eating habits prevents obstructions. Soaking expandable feeds including pelleted concentrates and beet pulp before feeding reduces obstruction risk. Monitoring eating behavior identifies horses with tendencies toward bolting feed that might benefit from slow-feed management strategies. Maintaining consistent feeding schedules and reducing competition during meals promotes calm, thorough chewing. Ensuring adequate water availability supports normal swallowing and esophageal function.

Post-injury monitoring and management potentially reduce stricture development following esophageal trauma. Close observation for swallowing difficulties in the weeks following choke episodes or other esophageal injuries enables early intervention. Keeping affected horses on soft, easily swallowed diets during the initial healing period reduces mechanical stress on damaged tissue. Some clinicians recommend anti-inflammatory therapy following significant esophageal injury, though evidence supporting stricture prevention remains limited. Follow-up endoscopy following severe injuries allows detection of developing strictures before complete lumen compromise occurs, potentially improving intervention outcomes.

Environmental modifications reducing esophageal injury risk contribute to overall stricture prevention. Designing feeding areas and equipment to minimize competition reduces rushed eating and obstruction risk. Ensuring appropriate dental care maintains adequate mastication capability preventing poorly chewed material from causing obstruction. Eliminating access to foreign materials that might be ingested reduces foreign body obstruction risk. Training personnel in proper nasogastric tube passage technique prevents iatrogenic injury. Maintaining emergency response capability ensures prompt treatment of any esophageal emergencies, minimizing tissue damage from prolonged obstruction.

Identifying and managing high-risk individuals helps target prevention efforts effectively. Horses with previous choke history require enhanced monitoring and feeding management. Those with known esophageal abnormalities or previous strictures need specialized protocols. Senior horses with declining dental function benefit from proactive dietary modifications. Documenting esophageal events and interventions creates records supporting identification of at-risk individuals and evaluation of prevention strategy effectiveness.

Daily management adjustments for horses with esophageal stricture focus on dietary modifications that enable adequate nutrition despite impaired swallowing capability. Feed consistency requires careful attention, with affected horses typically maintained on slurried or moistened feeds that pass strictures more easily than normal textures. Feeding frequency often increases to compensate for smaller meal sizes that avoid overwhelming the restricted esophageal capacity. All feeds should be offered in calm, low-stress environments that encourage relaxed, thorough chewing. Water should remain continuously available to support saliva production and feed passage. Supervision during feeding enables early intervention if difficulties develop.

Housing and turnout considerations balance nutritional management needs with quality of life factors. Individual feeding arrangements may be necessary to ensure affected horses consume their specialized diets without competition. Turnout scheduling should accommodate modified feeding requirements while maintaining beneficial exercise and social interaction. Grazing management prevents access to coarse pasture that might cause obstruction, though some horses tolerate carefully managed grazing. Shelter arrangements should protect specialized feeds from weather that might alter moisture content. Companion arrangements supporting psychological wellbeing remain important despite management challenges.

Exercise modifications for horses with esophageal stricture primarily involve timing relative to feeding and recognition of reduced exercise tolerance in nutritionally compromised individuals. Avoiding exercise immediately after feeding prevents regurgitation risk and allows undisturbed swallowing. Horses maintaining poor body condition despite management may have limited exercise capacity warranting reduced work intensity. Monitoring during and after exercise identifies horses experiencing difficulty that might indicate inadequate nutritional support. Many horses with well-managed strictures continue normal activities appropriate to their condition severity.

Monitoring and ongoing care protocols enable early problem detection and treatment response assessment. Daily observation during feeding identifies developing difficulties before acute obstruction occurs. Regular body weight and condition scoring provides objective nutritional assessment. Scheduling periodic veterinary evaluations including potential follow-up endoscopy monitors stricture status. Maintaining detailed records of feed intake, episodes of difficulty, and treatment interventions supports management refinement. Establishing emergency protocols and contacts ensures rapid response to acute obstructions.

Quality of life and use considerations guide management decisions for horses with esophageal stricture. Many affected horses maintain acceptable quality of life with appropriate dietary management, continuing to engage in normal activities and social interactions. Others face such severe restrictions that quality of life becomes questionable despite intensive management. Honest assessment of whether individual horses can maintain adequate nutrition, comfort, and normal behaviors guides difficult decisions about treatment intensity and continuation. Performance expectations may require modification, as some horses cannot maintain body condition supporting athletic demands. Breeding is generally inadvisable for horses requiring intensive stricture management, though the condition itself is not hereditary. With thoughtful management prioritizing individual horse welfare, many stricture patients enjoy meaningful quality of life.

High-risk breeds for esophageal stricture relate primarily to choke susceptibility and management practices rather than direct stricture predisposition. Breeds with elevated choke risk, including greedy-eating Thoroughbreds and small-esophagus miniature horses, face correspondingly increased stricture risk when obstructions cause esophageal damage. Draft breeds consuming large feed volumes may experience more severe obstructions when they occur. Arabians and other breeds sometimes displaying sensitive temperaments may experience anxiety-related eating behaviors contributing to choke susceptibility. However, individual factors including dental health, management practices, and accident history matter more than breed for most stricture cases.

Use and discipline considerations affect stricture risk through their association with esophageal injury causes. Performance horses traveling frequently face increased exposure to management disruptions that might contribute to choke episodes. Racehorses and other horses receiving high-concentrate diets may face elevated obstruction risk. Breeding operations handling large numbers of horses may experience statistical accumulation of choke cases simply due to population size. Retired horses transitioning management programs face adjustment periods that might affect eating behaviors. Any horse requiring frequent nasogastric intubation faces increased iatrogenic injury risk. Individual variation within any use category emphasizes that management quality matters more than discipline for most horses.

Genetic testing and breeding recommendations for esophageal stricture prevention are limited because the condition represents an acquired injury response rather than inherited disease. No genetic markers have been identified for stricture susceptibility, and the condition does not appear to follow hereditary patterns. However, horses requiring intensive stricture management may not be appropriate breeding candidates due to management demands and potential inability to maintain adequate condition during pregnancy and lactation. Selecting breeding stock with calm temperaments and appropriate eating behaviors may reduce offspring choke risk. Recording and sharing information about choke and stricture history helps identify any patterns that might warrant investigation. Responsible ownership involves recognizing stricture as a potential complication of esophageal injury regardless of breeding background.

Commonly co-occurring conditions with esophageal stricture reflect both the causes and consequences of esophageal narrowing. Choke represents both a precipitating factor and ongoing complication, with stricture patients experiencing recurrent obstruction episodes at the narrowed site. Aspiration pneumonia develops when regurgitated material enters the respiratory tract, requiring prompt antibiotic treatment and potentially causing chronic respiratory compromise. Malnutrition and poor body condition accompany strictures that prevent adequate feed intake despite management modifications. Gastric ulcers may develop or worsen due to altered feeding patterns and stress associated with chronic disease. Dental disease may represent an underlying factor that contributed to original choke episodes causing stricture.

Conditions with similar symptoms requiring differentiation from esophageal stricture include other causes of recurrent dysphagia and regurgitation. Megaesophagus involves esophageal dilation rather than narrowing but produces similar swallowing difficulties and regurgitation. Esophageal diverticulum creates an outpouching that may trap feed material, causing symptoms resembling stricture. External compression from masses, abscesses, or enlarged structures can narrow the esophageal lumen without intrinsic wall disease. Esophageal tumors, though rare, cause progressive obstruction that may mimic stricture. Neuromuscular disorders affecting esophageal motility produce dysphagia without anatomical narrowing. Recurrent choke without stricture may occur in horses with severe dental disease or other factors promoting repeated obstruction independent of esophageal anatomy.

Potential complications of esophageal stricture include several serious conditions that may develop during the disease course or following treatment. Aspiration pneumonia represents the most common serious complication, with each regurgitation episode creating respiratory infection risk. Complete esophageal obstruction at the stricture site constitutes an emergency requiring prompt intervention. Esophageal perforation may occur spontaneously from severe obstruction or as a complication of dilation procedures, creating life-threatening septic contamination. Stricture progression and treatment failure may ultimately result in inability to maintain adequate nutrition despite intensive management. Complications of surgical intervention include anastomotic dehiscence and recurrent stricture formation at surgical sites.