Introduction: Long (≥2-5cm) and ultra-long (≥5cm) esophageal strictures have been reported after endoscopic mucosal resection, ablation and radiation. In contrast to short strictures, their outcome is unclear and treatment relies on expert opinion from small case series. Aim: To investigate the outcome of ultra-long benign, intrinsic esophageal strictures. Methods: All patients who underwent endoscopic treatment of benign, intrinsic esophageal strictures of ≥2cm length at a single tertiary between 7/2010 and 5/2014. Data was abstracted by retrospective chart review, including stricture etiology, duration of presence of stricture, endoscopic procedures and long-term outcome. The main endpoints were to calculate the treatment success defined as improved dysphagia score, resolution of dysphagia, and the rate of gastrostomy-dependent patients and patients requiring esophagectomy.Figure 1Results: 83 patients (mean age 63years, SD 16.9; 54% female) were followed over 16months (median) at our facility for esophageal strictures. Stricture etiology included peptic 23%, radiation 26%, anastomotic 11%, post-ablation 11%, post-EMR 10%, dermatologic conditions 10% and others 9% strictures, with a mean length of 43mm and mean diameter of 8.4mm. Median dysphagia score at presentation to our facility was 2 (able to swallow semi-solid only). Patients underwent a median of 7 dilations, which correspondents with 0.3 dilations per months. Only a minority of patients underwent in addition to dilation argon plasma tissue vaporization, stent placement, steroid and Mitomycin-C application. Median dysphagia score remained unchanged at 2, with 14% of patients having resolution of dysphagia, whereas 61% patients experienced unchanged or worsened dysphagia. 25% were eventually gastrostomydependent and 4% required esophagectomy. Stricture length and diameter remained not significantly changed at end of follow up. Kaplan-Meier analysis delineated resolution of dysphagia according to stricture length: 50% in strictures 2.0-4.9cm, 12.5% in 5.0-9.9cm and 0% in ≥10.0cm. Limitations: Single center, retrospective study, heterogeneous cohort. Conclusion: Endoscopic treatment is effective in only 50% for long (≥2-5cm) esophageal strictures as reflected by improvement of dysphagia score. However, dysphagia remained unchanged in most ultralong strictures (≥5cm). Gastrostomy or esophagectomy were long-term required in 29% of strictures ≥2cm.