Advances in the treatment of postoperative anastomotic strictures in esophageal cancer a comparative analysis of the efficacy of endoscopic versus interventional dilatation.

BACKGROUND

Postoperative anastomotic stricture is a frequent and debilitating complication following esophageal cancer surgery, significantly diminishing patients' quality of life by causing dysphagia and impaired nutrient intake. Current standard treatments, such as balloon dilatation, often cause widespread concern due to high recurrence rates and potential complications like perforation.

AIM: This paper aims to provide a comprehensive analysis of the efficacy, safety, and recurrence rates of endoscopic and interventional dilatation techniques in treating postoperative anastomotic strictures in esophageal cancer patients.

METHODS

This narrative review synthesizes current clinical evidence on endoscopic dilatation (balloon dilatation, endoscopic incisional therapy) and interventional radiology dilatation techniques. Comparative analysis was performed across five core indicators: technical success rate, short-term remission rate, recurrence rate, severe complication rate, and average recurrence time.

RESULTS

Endoscopic balloon dilatation demonstrated technical success rates of 94.9%-96.3% and short-term clinical efficacy up to 94.3%, with perforation rates of 0.53%-0.6%. Endoscopic incisional therapy showed superior outcomes with 0% recurrence versus 44.4% for traditional dilatation in comparative studies. Interventional dilatation exhibited wide technical success variability (83%-100%) and was positively correlated with refractory stricture development (OR=8.92). Recurrence after endoscopic dilatation occurred in approximately 30% of patients within 6 months, with average recurrence time of 144 days. Combined endoscopic incision with balloon dilatation demonstrated synergistic effects, improving patency and reducing re-stenosis.

CONCLUSION

Endoscopic techniques, particularly combined incisional and balloon dilatation, offer superior efficacy and safety profiles compared to interventional dilatation alone. Individualized treatment approaches considering stricture morphology, length, and patient factors are essential. Future directions include biomaterial integration, anti-scarring agents, and multidisciplinary team-based precision medicine strategies to optimize long-term outcomes.