Esophageal stricture is the principal complication associated with endoscopic resection (ER) in patients with superficial esophageal cancer (SEC), and medical intervention may be required to prevent esophageal stricture after ER. The aim of this study was to compare acellular dermal matrix (ADM) transplantation and esophageal mucosal autograft (EMA) transplantation in terms of efficacy in preventing esophageal stricture after ER for SEC.

Between May 2017 and November 2022, 48 patients with SEC who underwent EMA or ADM after ER were enrolled in this study. The primary outcomes measured included esophageal stricture, refractory esophageal stricture, and the number of endoscopic dilations after esophageal stricture.

A total of 48 patients with SEC were enrolled in this study, 17 of whom underwent EMA after ER (EMA group) and 31 of whom underwent ADM after ER (ADM group). The median of total procedure duration and the median of transplantation duration in the ADM group was significantly shorter than that in the EMA group (Z = − 2.408, P = 0.016; Z = − 2.710, P = 0.006). During the follow-up, 4 patients developed refractory esophageal stricture in the EMA group and 1 developed refractory esophageal stricture in the ADM group. The rate of refractory esophageal stricture was lower in ADM group than in EMA group (3.2% vs. 23.5%, P = 0.047). In patients with > 3/4 circumferential range ER, the rate of refractory esophageal stricture was also lower in ADM group than in EMA group (4.0% vs. 25.0%, P = 0.067). Among the patients who developed esophageal stricture, the median number of endoscopic dilations in the ADM group was less than that in the EMA group (Z = 27.500; P = 0.040).

Compared with EMA, ADM provided several advantages, as it reduced the number of endoscopic dilations for patients with esophageal strictures and shortened the procedure duration for patients who underwent esophageal ESD.