Objective To observe the therapeutic effect of digital subtraction angiography（DSA）guided gradient pressuring by staged balloon dilation on anastomotic stenosis.in patients with esophageal cancer. Methods Totally，120 patients with anastomotic stenosis admitted to our hospital from August 2020 to August 2022 were enrolled in the study. Fifty ⁃seven of them treated with endoscopic gradient pressuring by staged balloon dilatation were set as the control group，and the other 63 ones treated with DSA guided gradient pressuring with staged balloon dilatation were set as the observation group. The two groups were compared in terms of total response rate， dilation times，and complications of postoperative esophageal stenosis，swallowing function，anastomotic stenosis diameter，quality of life score，and nutritional index before and after surgery. Results The total response rate in the observation group and the control group was 98.41% and 89.47%，respectively，with significant difference between them（P = 0.037），The number of expansion in the observation group was significantly lower than that in the control group（P < 0.001）. Reduclower swallowing function scores in both groups were significantly lower as compared with preoperative swallowing function and the score of the observation group was significantly lower than that of the control group after operation（P < 0.001）. The diameters of anastomotic stenosis in both groups after operation were significantly increased as compared to the preoperative，and that of the observation group was significantly larger than that of the control group after operation（P < 0.001）. The incidence of postoperative bleeding in the observation group was significantly lower than that in the control group（20.63% vs. 47.37%，P = 0.002）. The scores of QOL in both groups were elevated one month after surgery as compared with the preoperative and the scores of emotional function and social function in the observation group were significantly higher than those of the control group（P = 0.015，0.016）. After surgery，the levels of serum retinol⁃binding protein（RBP），hemoglobin（Hb）and transferrin （TF）were all increased in both groups，and the levels in the observation group were significantly higher than those in the control group（P < 0.001）. The postoperative level of ALB was significantly higher than the preoperative one in the observation group（P < 0.05）and after operation，the level of ALB in the postoperative observation group was significantly higher than that in the control group（P = 0.045）. Conclusion DSA guided gradient pressuring with staged balloon dilation has better therapeutic effect on anastomotic stenosis in esophageal cancer patients and the nutritional index level in the patients is higher，thereby deserving clinical spreading.