Endoscopic Conical Cap Dilatation: A Novel Alternative to Balloon Dilatation for Esophageal Stricture After Endoscopic Submucosal Dissection

Abstract Background and study aims Esophageal stricture is a common complication after extensive endoscopic submucosal dissection (ESD) for superficial esophageal cancer, requiring multiple interventions with substantial medical costs. Endoscopic conical cap dilatation is a novel, minimally invasive technique invented by Jinfeng Zhou, but its efficacy and safety compared to conventional endoscopic balloon dilatation remain unclear. Patients and methods We conducted a retrospective case-control study involving patients who developed esophageal strictures after ESD and underwent either endoscopic conical cap dilatation (n = 32) or endoscopic balloon dilatation (n = 64) between January 2020 and December 2024. The primary outcome was the stricture recurrence rate within 12 months. Secondary outcomes included technical success rate, number of dilatation sessions, procedure time, dysphagia improvement (Eckardt score), and complication rates. Results The endoscopic conical cap dilatation group had a significantly lower 12-month recurrence rate (22.6% vs. 56.7%, P = 0.002) and required fewer dilatation sessions (median 3 [2–4] vs. 5 [3–7], P < 0.001). Technical success rates were comparable (96.9% vs. 93.8%, P = 0.572). Procedure time was shorter in the endoscopic conical cap dilatation group (median 2 min [1–3] vs. 6 min [3–8], P < 0.001). Both groups showed significant Eckardt score improvement at 1 month (P < 0.001), with no between-group difference (P = 0.326). Complication rates were low (3.1% vs. 4.7%, P = 0.725), with no perforations in the endoscopic conical cap dilatation group. Conclusions This single-center retrospective cohort shows endoscopic conical cap dilatation yields promising preliminary results for post-ESD esophageal strictures, with lower recurrence, fewer sessions and shorter procedures and comparable safety versus balloon dilation. Further large randomized studies are required to confirm these findings.