Endoscopic Incisional Therapy for Benign Esophageal Strictures

BACKGROUND: Endoscopic incisional therapy (EIT) is a minimally invasive alternative treatment, but its long-term efficacy and safety remain unclear. We conducted a systematic review and meta-analysis to assess the outcomes of EIT for benign esophageal strictures (BES). METHODS: A systematic search of PubMed, EMBASE, Cochrane Library, and Google Scholar was conducted in accordance with PRISMA 2020. Studies reporting outcomes of EIT in BES were included. Pooled estimates for technical success, clinical success (1, 6, 12, and 24 mo), subgroup outcomes (short vs. long segment, naive vs. refractory), and adverse events were calculated using the Freeman-Tukey double arcsine transformation and a random-effects model. RESULTS: Fourteen studies comprising 396 patients were included. The pooled technical success rate was 98.5% (95% CI: 97.0-99.4; I²=0%). Clinical success declined over time: 88.1% (95% CI: 78.0-95.4) at 1 month, 63.6% (95% CI: 48.6-77.5) at 6 months, 52.0% (95% CI: 35.7-68.1) at 12 months, and 61.6% (95% CI: 22.3-93.5) at 24 months. In subgroup analysis, short-segment strictures (<1 cm) achieved high clinical success (92.5%, 95% CI: 83.2-98.3), while long-segment strictures (>1 cm) had substantially lower outcomes (16.4%, 95% CI: 7.1-28.6). Naive strictures demonstrated superior results (82.8%, 95% CI: 66.0-94.6) compared with refractory strictures (43.9%, 95% CI: 30.4-57.8). CONCLUSION: EIT is an effective and safe treatment for benign esophageal strictures, especially in short-segment and naive cases. It shows excellent short-term results, but recurrence is common, and long-term outcomes are less consistent in long-segment and refractory strictures.