Objective To analyze the risk factors for refractory anastomotic stricture after esophagectomy.Methods Clinical data of 104 patients with benign anastomotic stricture after esophageal cancer operation and endoscopic treatment was retrospectively reviewed. The effect of endoscopic treatment was recorded. According to the sessions of endoscopic dilation, anastomotic stricture patients were divided into refractory stricture group ( > 5 times, n = 37) and non-refractory stricture group (≤ 5 times, n = 67). Univariate and multivariate Logistic regression analyses were used to investigate the potential risk factors for the refractory anastomotic stricture.Results Univariate analysis showed that there were significant differences in anastomotic location, anastomat type, intraoperative hemorrhage, operative time, postoperative anastomotic leakage, interval of stricture after surgery, postoperative radiotherapy, time to feeding after endoscopic treatment, endoscopic treatment and anastomotic diameter after dilation (P < 0.05). Multivariate Logistic regression indicated high anastomosis, postoperative anastomotic leakage, postoperative radiotherapy, simple endoscopic dilation and the anastomotic diameter after endoscopic dilation < 13 mm were the independent influencing factors of refractory anastomotic stricture.Conclusion The anastomotic stricture should be dilated to 13 mm and above in diameter, combined with locoregional anti-stenosis drug injections, especially for patients with anastomotic stenosis located in the upper part of esophagus, postoperative anastomotic leakage and radiotherapy.