Benefits of precise endoscopic incision on post-dilation mucosal scars to treat refractory esophageal stricture after endoscopic submucosal dissection

Abstract

Endoscopic dilation (ED) is the mainstream treatment for esophageal stricture after endoscopic submucosal dissection (ESD). However, some complex esophageal strictures do not respond well to dilation. Endoscopic radial incision (ERI) has proved to be effective in treating anastomotic strictures, but it is rarely used to treat post-ESD esophageal strictures due to technical difficulties and risks, not to mention the optimal method and timing to perform ERI. Here, we developed an integrated procedure in which ED was performed first, followed by ERI on the stiff scars that remained intact after dilation. The ED + ERI procedure resulted in complete, uniform expansion of the esophageal lumen. Between 2019 and 2022, 5 post-ESD patients who received a median number of 11 sessions of ED (range, 4-28) of ED over a period of 322 days (range, 246-584) but still had moderate to severe dysphagia were admitted. 2 or 3 sessions of ED + ERI were performed for each patient interspersed with ED. After a median number of 4 treatments (range, 2-9), all patients were symptom-free or had minimal symptoms. No serious complications occurred in any patients who underwent ED + ERI. Therefore, ED + ERI is safe, feasible, and may serve as a useful therapeutic method for refractory esophageal stricture after ESD.