Advances in the Prevention and Treatment of Post-ESD Stricture in Early Esophageal Cancer

Abstract: As the standard treatment for early esophageal cancer and its precancerous lesions, Endoscopic Submucosal Dissection (ESD) offers advantages including effective lesion dissection and resection, minimal invasiveness, rapid recovery, and a high safety profile. However, post-ESD esophageal stenosis remains one of the most common and serious complications, particularly in cases involving large mucosal defects with a circumferential extent ≥3/4 or a longitudinal length ≥5 cm, where the incidence can reach 70%-100%. Current preventive strategies primarily include pharmacological interventions (e.g., corticosteroids, botulinum toxin A), mechanical interventions (balloon dilation, stent placement), tissue-shielding techniques (PGA sheets, hydrogels), and regenerative medicine approaches (cell sheet technology, stem cell therapy). For established stenosis, especially refractory cases, various advanced endoscopic techniques have demonstrated significant efficacy. Combined treatment strategies, such as sequential ESD-radiofrequency ablation (RFA) therapy and endoscopic vacuum therapy (EVT) combined with medications, represent future research directions. This article systematically reviews the risk factors, preventive measures, and treatment methods for esophageal stenosis following ESD for early esophageal cancer.