Endoscopic Incisional Therapy for Benign Esophageal Strictures: A Systematic Review and Meta-Analysis

Area of Science:

• Gastroenterology
• Minimally Invasive Surgery
• Endoscopy

Background:

• Benign esophageal strictures (BES) pose treatment challenges.
• Endoscopic incisional therapy (EIT) is a minimally invasive option.
• Long-term efficacy and safety of EIT for BES require evaluation.

Purpose of the Study:

• To systematically review and meta-analyze outcomes of EIT for BES.
• To assess technical success, clinical success rates, and adverse events.
• To compare outcomes based on stricture characteristics (segment length, refractory status).

Main Methods:

• Systematic literature search (PubMed, EMBASE, Cochrane, Google Scholar) following PRISMA 2020 guidelines.
• Inclusion of studies reporting EIT outcomes in benign esophageal strictures.
• Meta-analysis using random-effects model to pool technical success, clinical success at various time points, and subgroup analyses.

Main Results:

• Fourteen studies with 396 patients were analyzed.
• Pooled technical success rate was high at 98.5%.
• Clinical success declined over time (88.1% at 1 month to 61.6% at 24 months).
• Short-segment (92.5%) and naive (82.8%) strictures showed higher success than long-segment (16.4%) and refractory (43.9%) strictures.

Conclusions:

• EIT is effective and safe for benign esophageal strictures, particularly short-segment and naive cases.
• Excellent short-term results are observed.
• Long-term outcomes are less consistent, with common recurrence, especially in long-segment and refractory strictures.