Endoscopic treatment of benign esophageal strictures: Advances and challenges

Table 1 Common methods of endoscopic dilation for benign esophageal stenosis

Treatment methods	Indications	Whether to use radiation assistance	Advantages	Disadvantages
Guide-wire-free bougie	Simple stenosis of the distal esophagus	No	Simple to operate, and patients can use it at home	It is only applicable in simple linear stenosis
Guide-wire-assisted bougie	Complex stenosis of the distal esophagus	Yes	Cost-effective and reusable. Guidance by a guide wire makes it safer	It is not applicable in severe stenosis
Endoscopic balloon	Complex or severe stenosis of the esophagus	Yes	Dilation effect is definite, and it can be applied in a wider range of scenarios	Cost is high and the operation process is relatively complex

Table 2 Summary of endoscopic treatment for benign esophageal stenosis

Treatment methods	Applicable scenarios	Advantages	Disadvantages
Dilation	The vast majority of benign esophageal stenoses	The first-choice treatment method with a wide range of applicable scenarios	High recurrence rate after dilation, requiring repeated treatments
Medication	Reflux-related stenosis or stenosis after ESD	Can intervene in the early process of esophageal stenosis and has a certain preventive effect	The effect of drug alone is not definite and it is often used in combination with dilation and other methods
Stenosis incision	Refractory Schatzki ring and short-segment anastomotic stenosis (< 1 cm)	Definite effect and good effect on annular stenosis	Difficult to operate, high risk of perforation, and the scar after cutting is prone to causing restenosis
Stenting	Refractory or recurrent stenosis, sealing benign esophageal leaks and perforations	It can control potential inflammation, and the scar tissue may also undergo remodeling, thus achieving continuous lumen patency	The long-term effect of the stent is not good. About one-third of patients have a poor effect in terms of long-term relief of dysphagia, and the displacement rate is relatively high
Flap transplantation	Prevention of stenosis after ESD for large-area esophageal lesions	Significantly reduces the incidence of stenosis after endoscopic circumferential mucosal resection of the esophagus. Flap transplantation avoids repeated dilation of esophageal stenosis and damage to the esophagus	Is a cutting-edge technology, less carried out, and requires relevant basic and clinical research for further verification

ESD: Endoscopic submucosal dissection.