Table 3. The advantages and limitations of strategies to prevent esophageal stricture after ESD.

Method	Approaches	Advantages	Limitations
Pharmacological prophylaxis	Systemic steroid	Powerful anti-inflammatory and anti-fibrotic effect, convenient for patients to take	Systematic side effects (immunosuppression, osteoporosis, gastrointestinal bleeding, electrolyte imbalance). Have little efficacy for those with circumferential mucosal defects
	Local injection of steroid	Strong inhibition of inflammation, Reducing systematic side effect	Delayed wound healing; local reaction (perforation, mediastinal abscess, pleural effusion). Have little efficacy for those with circumferential mucosal defects
Mechanical strategies	Endoscopic balloon dilatation	Through mechanical expansion to prevent esophageal stricture, no systemic side effects, long clinical use, quick effect	Requiring multiple dilatations, consuming lots of time, feeling uncomfortable, having the risk of bleeding, perforation, bacteremia, restricture
	SEMSs implantation	Continuous dilation effect, removal at any time after the relief of esophageal stricture	Chest pain, gastrointestinal bleeding, hyperplasia of granulation tissue, and stent displacement
	Biodegradable stents implantation	No long-term complications, no need for removal, avoid re-injury of the esophagus	High cost, poor self-expansion, stent migration
Tissue engineering strategies	Cell sheets transplantation	Rich source of cells, great potential for development	Still in preclinical study stage, high cost, complicated operation, strict technical requirements
	Extracellular matrix stents	Promoting tissue repair and ulcer healing, inducing site-specific remodeling of esophageal tissue, having no pro-inflammatory effect	Inadequate clinical research
Autologous transplantation	Autologous esophageal mucosa, stomach mucosa and skin transplantation	Convenient, cheap, easy to acquire, good preventive effect, good histocompatibility	Inadequate clinical research
Other novel strategies	Polyglycolic acid	excellent biocompatibility and nontoxicity, reducing inflammatory responses and promoting epithelial cell regeneration	Inadequate clinical research
	Carboxymethyl cellulose	inducing wound healing and scar inhibition	Inadequate clinical research