Objective To investigate the therapeutic efficacy of endoscopic radial incision (ERI) in the treatment of refractory anastomotic stenosis after esophageal surgery. Methods Sixty-six patients with refractory esophageal anastomotic stenosis in our hospital between January 2021 and December 2023 were selected. The patients were treated with ERI or Savary-Gilliard bougie dilation (SGBD). The effect of relieving anastomotic stenosis was evaluated. Adverse events such as intraoperative bleeding, myometrial injury, and perforation were also assessed. Results A total of 266 endoscopic procedures were performed on the 66 patients. Among these, 30 procedures utilized ERI and 236 utilized SGBD. The patients in the ERI group were significantly older than those in the SGBD group (P = 0. 017). The ERI group had a smaller preoperative anastomotic stenosis diameter than the SGBD group (P<0. 001). The ERI group had a longer stenosis segment length than the SGBD group ( P = 0. 001). The post-dilation anastomotic diameter was significantly larger in the ERI group than that in the SGBD group (P = 0. 012). However, the operation time was significantly longer in the ERI group than that in the SGBD group (P<0. 001). There were no statistically significant differences in remission time and surgical adverse events between the two groups ( P>0. 05). When the patients were stratified according to the degree of stenosis, it was found that for patients with moderate to severe stenosis, the short-term recurrence rate of stenosis in the ERI group was significantly lower than that in the SGBD group during the follow-up observation period within 1 month, 1 to 3 months, 3 to 6 months, 6 to 12 months, and more than 12 months after surgery (P<0. 05). Additionally, the incidence of muscle layer injury was significantly lower in the ERI group than that in the SGBD group ( P = 0. 025). Conclusions For patients with moderate-to-severe refractory stenosis, ERI can achieve better dilution effect. It can also reduce the occurrence of adverse events.