Endoscopic management for upper gastrointestinal stricture has been discussed. First-line treatment for unresectable esophageal cancer is chemothepary (or chemoradiotheapy). When the first-line treatment is not effective, intubation of self expandable metallic stent (SEMS) is considered. A poor-risk patient who has no tolerance to radiochemotherapy is also a candidate for direct SEMS stenting. Prompt recovery from dysphagia is the major advantage to SEMS stenting. Nevertheless, SEMS stenting is a non-curative treatment to the original disease and it induces a temporary relief only from dysphasia. Bleeding, perforation, and re-stenosis are often encountered drawbacks after intubation of SEMS. Stricture after widespread EMR may also be successfully controlled by temporarily stenting of covered SEMS. Balloon dilatation or Botox injection is used to control stricture in achalasia, but the effectiveness is limited to short duration of relief from dysphasia. For complete response to stricture of achalasia, laparoscopic surgery is mandatory.
Stenting to gastric outlet obstruction is one of the treatment choices that induces temporary but rapid recovery from dysphasia. However, the patient is still exposed to risks of bleeding, perforation, and re-stenosis continuously after SEMS intubation. Its efficacy should be clarified by further studies. Chemotherapy is also recognized as a first-line treatment for unresectable gastric cancer. Chemotherapy has a small chance to cure the disease, but stenting has no chance to cure the cancerous disease.