Esophageal stents are widely used to restore luminal patency in patients suffering from malignant or benign esophageal strictures. Despite the clinical success of self-expanding metallic and plastic stents, complications such as migration, restenosis, and interference with normal peristalsis remain unsolved challenges. Recent advances in biodegradable materials, 3D printing, and computational biomechanics offer new opportunities for designing patient-specific, physiologically compatible esophageal stents. Moreover, understanding the biomechanics of esophageal peristalsis—particularly the coordination of circular and longitudinal muscle contractions—is crucial for improving stent–tissue interactions. This review provides an overview of recent progress in stent materials, design strategies, and finite element modeling, as well as physiological models of esophageal peristalsis and their implications for future stent development.