Scar incision and endoscopic balloon dilation for severe benign esophageal strictures.

Background and Aims: Endoscopic balloon dilatation (EBD) is the primary treatment for benign esophageal strictures after endoscopic or surgical resection of esophageal cancer. Resolving these strictures often requires multiple sessions over time and risks perforation. To address these challenges, we developed a combined technique integrating scar incision with EBD, wherein scar incisions are created using a needle-knife before balloon dilation. Methods: Linear incisions were made at the stricture site using a needle-knife, targeting areas with pronounced fibrosis or requiring tension release. Subsequently, EBD was performed to dilate the entire stricture site. These procedures were performed in 1 session. Additional EBD or EBD with scar incision sessions were conducted at intervals until patients became asymptomatic. Results: We evaluated EBD with scar incision in 5 patients with severe esophageal strictures after endoscopic or surgical resection for esophageal cancer. All patients became asymptomatic within 3 months. One patient experienced restricture 139 days after the final EBD but improved after an additional EBD session. No adverse events requiring intervention occurred. Conclusions: EBD with scar incision effectively achieves asymptomatic resolution within a short period. Pre-creating incisions with a needle-knife enhances the efficacy and safety of balloon dilation.