Endoscopic incisional balloon dilation combined with anti-scarring agents for postoperative esophageal anastomotic strictures

Abstract

The management of locally advanced esophageal cancer typically involves esophagectomy; however, postoperative complications, particularly anastomotic stricture, remain prevalent. Anastomotic stricture can severely compromise patients' quality of life by leading to difficulties in food intake. Although endoscopic balloon dilation has become a standard treatment for gastrointestinal strictures, its efficacy is often limited due to the risk of perforation and the potential for recurrent stricture, necessitating multiple interventions. Recent advancements have introduced endoscopic radial incision and cutting methods, which aim to enhance patency by excising scar tissue. We experienced a case resistant to the radial incision and cutting therapy, necessitating further intervention strategies. This report details our experience utilizing a novel technique, endoscopic incisional balloon dilation, which combines endoscopic incisional technique and balloon dilation therapy with anti-scarring medications, in cases of refractory anastomotic strictures following esophageal cancer resection. We present three challenging cases in which endoscopic incisional balloon dilation yielded significant clinical improvements, alongside supportive literature. Our findings suggest that endoscopic incisional balloon dilation is an effective and safer alternative to conventional methods, capable of addressing complex stricture scenarios while potentially enhancing patient outcomes and quality of life.