Background <p>Endoscopic balloon dilation (EBD) is the standard treatment for benign esophageal stenosis (BES), but restenosis is common. Although EBD with triamcinolone acetonide injection (EBD-TA) reduces restenosis, dense fibrotic stenoses often show limited distensibility. We introduced a modified endoscopic dilation technique, radial incision and balloon dilation (RIBD), which integrates longitudinal incisions with balloon dilation and adjunctive TA injection, and evaluated its initial clinical outcomes in patients with BES.</p> Methods <p>This retrospective single-center study included 66 patients who underwent endoscopic treatment for BES. RIBD was introduced in 2022, and its initial clinical outcomes were assessed with historical comparison with EBD and EBD-TA. The primary outcome was restenosis. Secondary outcomes were the number of dilation sessions, refractory stenosis, and adverse events.</p> Results <p>RIBD was used as the sole treatment in 15 patients and as secondary treatment in 12. Restenosis after RIBD occurred in 1/15 patients (6.7%) in the single-method group and 2/12 (16.7%) in the multiple-methods group. The median number of dilation sessions was 1 (IQR, 1–1) in both groups. No refractory stenosis or adverse events were observed after RIBD. In exploratory historical comparisons, RIBD was associated with lower restenosis rates and fewer dilation sessions than both EBD and EBD-TA.</p> Conclusion <p>RIBD is a modified endoscopic dilation technique that improves the extensibility of fibrotic esophageal stenoses while minimizing deep mucosal injury, and may represent a useful treatment option in selected patients with BES.</p> <p>Key words: esophageal stenosis; balloon dilation; restenosis; triamcinolone acetonide; radial incision</p>