Background and Aims <p>Pediatric esophageal strictures present a significant clinical challenge. Recently, endoscopic incisional therapy has gained attention as a novel treatment approach. This study aims to assess the efficacy and safety of this procedure in managing pediatric esophageal strictures and to identify factors that influence treatment outcomes.</p> Methods <p>This retrospective cohort study analyzed endoscopic incisional therapy procedures performed on pediatric patients at a tertiary care center between November 2019 and May 2023. Patient demographics, stricture characteristics, procedural details, and clinical outcomes were collected. Treatment success was defined as complete symptom resolution without further intervention for at least three months, while improvement indicated symptom reduction requiring additional treatment, and failure necessitated surgery. Fisher’s exact and Wilcoxon-Mann-Whitney tests were used to assess associations between variables and outcomes.</p> Results <p>The cohort consisted of 22 pediatric patients (mean age 6.6 ± 6.1 years; 41% female) who underwent a total of 101 procedures, including balloon dilation in 63 cases. Stricture etiologies included tracheoesophageal fistula (50%), caustic ingestion (27%) and others. Complete symptom resolution occurred in 68% of patients, while 23% showed improvement, and 9% required surgery. No significant associations were found between outcome and stricture location, severity, etiology, or medications. However, multiple strictures (<i>p</i> = 0.005) and shorter intervals between procedures (<i>p</i> = 0.02) were associated with reduced success. No procedure-related complications were observed.</p> Conclusions <p>Endoscopic incisional therapy is a safe and effective treatment for pediatric esophageal strictures, achieving symptom resolution in most cases. Further studies are needed to optimize patient selection and refine treatment strategies.</p>