In this issue of Endoscopy, Walter et al. report on a multicen- ter exploratory study on the use of biodegradable stents in the treatment of benign esophageal strictures [1]. The authors conclude that biodegradable stents delay the need for retreat- ment due to recurrent dysphagia compared with dilation ther- apy alone. Walter et al. should be given accolades for this valu- able contribution to the growing literature on biodegradable endoprosthetics and for studying a difficult and heterogeneous patient population. The biodegradable endoprosthetic represents an evolution- ary technology that has clear theoretical benefits over other treatments for esophageal strictures. In benign refractory esophageal strictures, endoscopic resource utilization could potentially be reduced if biodegradable stents are placed, and subsequent replacement or dilation is performed only when dysphagia recurs. One of the most attractive features of the biodegradable stent, as demonstrated in the Walter et al. study, is that there were no reports of hyperplastic tissue growth or secondary stricture formation as may be seen with self-expandable metal stents (SEMS). Although the biodegrad- able stent is not a disruptive technology, it represents incre- mental innovation and appears to provide valuable improve- ments over existing endoprosthetic technologies for selected indications. In order to push the boundaries of innovation and patient care further, we must critically evaluate this study in or- der to assist in the evolution of this technology and to define the patient population that will most benefit from it. “For now, the use of protocolized dilation will remain the gold standard, but depending upon the individual patient situation, strategies utilizing biodegradable stents or self-bougienage may be appropriate.” When placing the use of a new technology into clinical perspec- tive, it is important to evaluate both the pathologic disease pro- cess to which the technology will be applied and also the tech- nology itself. In the case of benign esophageal strictures, defin- ing refractory and recurrent strictures is necessary to better de- lineate the exact patient population enrolled. Benign refractory strictures are those that cannot be remediated to a diameter of 14 mm over the course of five sessions at 2-week intervals [2]. Conversely, recurrent esophageal strictures are those in which the luminal diameter cannot be maintained once the 14 mm di- lation threshold has been reached [2]. The esophageal strictures in the Walter et al. study did not uniformly meet criteria for either recurrent or refractory eso- phageal strictures. The majority of the strictures were anasto- motic in etiology, but there were also multiple other types of Esophageal strictures: in search of the Goldilocks solution Referring to D. Walter et al. p. 1146–1155 Authors Gene K. Ma, Michael L. Kochman Institution Gastroenterology Division, Department of Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, United States Bibliography DOI https://doi.org/10.1055/a-0656-5650 Endoscopy 2018; 50: 1139–1140 © Georg Thieme Verlag KG Stuttgart · New York ISSN 0013-726X Corresponding author Michael L. Kochman, MD, Gastroenterology Division, Department of Medicine, University of Pennsylvania, 3400 Civic Center Boulevard, 7th Floor PCAM South, Room 711, Philadelphia, PA 19104, United States Fax: +1-215-349-5915 Michael.kochman@uphs.upenn.edu Editorial Gene K. Ma Michael L. Kochmann Ma Gene K et al. Treatment for esophageal strictures … Endoscopy 2018; 50: 1139–1140 1139 Downloaded by: Tulane University. Copyrighted material.