Refractory benign esophageal stricture (RBES) is a frequently encountered problem worldwide. These strictures arise from various causes such as corrosive injury, radiation therapy, peptic origin, ablative therapy, and after surgery. Most strictures can be treated successfully with endoscopic dilatation using bougies or balloons, with only a few complications. Those patients who fail after serial dilatation with bougies or balloons will come to the category of refractory strictures. Dilatation combined with intralesional steroid injections can be considered for peptic strictures, whereas incisional therapy has been demonstrated to be effective for short anastomotic strictures. When these therapeutic options do not resolve the stenosis, stent placement should be considered. Self-bougienage can be proposed to a selected group of patients with a proximal stenosis. Most of the patients of RBES respond to above-mentioned treatment and occasional patient may require surgery as the final treatment option. This review aims to provide a comprehensive approach toward endoscopic management of RBESs based on current literature and personal experience.

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We report a case of long rigid radiolucent foreign body “chewing wood stick (datun)” impacted in the stomach of a 50-year-old man. He was literate, without any history of psychiatric illness and had been using “datun” to clean his teeth for last 15 years. He presented with a history of accidental ingestion of “datun” 3 months back, it was found impacted in the stomach on percutaneous ultrasonography and was removed with endoscopy using rat tooth forceps and snare.

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