Daniela Leon-Jarrin, MD1, Manoj Kumar, MD1, Yazan Fahmawi, MD1, Meir Mizrahi, MD2
1University of South Alabama, Mobile, AL; 2University of South Alabama College of Medicine, Spanish Fort, AL
Introduction: Common causes for benign esophageal strictures (ES) are post -surgery, caustic ingestions and radiation therapy. Caustic strictures of the gastrointestinal tract can be a challenge to treat even after multiple endoscopic treatments due to its inherent relapsing nature. We report here our experience with self-expandable metallic stents (SEMS) in a patient with corrosive stricture of the esophagus.
Case Description/Methods: A 25-year-old female with 2-year history of refractory ES due to caustic injury presented for endoscopic treatment. Patient had multiple endoscopic dilation attempts in past. Pediatric gastroscope showed esophageal stricture starting at 20cm from the incisors however it could not traverse through the stricture. Under fluoroscopic guidance a 0.035 in x 260 cm guidewire was placed in the stomach. The proximal end of stricture was occluded by biliary 8.5mm stone extraction balloon and contrast was injected through balloon catheter under fluoroscopy guidance showing 12 cm long significantly narrowed ES. A 18mm x 103 mm fully covered esophageal metal stent (FCEMS) was placed under fluoroscopic guidance keeping the distal end of the stent above the gastroesophageal junction. Four days later, follow up EGD showed previously placed FCEMS was patent and widely open. The distal end of the stent was at 27cm and GEJ was at 35cm from entry point. Under fluoroscopic imaging and wire guidance another FCEMS (18 mm x 153 mm) was placed successfully to treat the left-over portion of the stricture below the previously placed stent. The second stent was deployed with in the first stent with its distal end at GEJ. Post stent placement, endoscopic and fluoroscopic imaging’s were satisfactory. At 2 weeks follow up, patient revealed significant improvement in her symptoms and ability to tolerate soft diet.
Discussion: ES secondary to caustic injury tend to require multiple dilation procedures, multiple hospitalizations with associated risks and cost, affecting patient’s quality of life. There is a need for novel therapeutic strategies that will provide a long-term solution. Our case highlights the growing interest and utility of multiple FCEMS in the treatment of severe and long ES. The deployment of multiple FCEMSs in our patient with long history of ES related dysphagia dramatically improved her symptoms and patency of esophagus.
Citation: Daniela Leon-Jarrin, MD; Manoj Kumar, MD; Yazan Fahmawi, MD; Meir Mizrahi, MD. P0323 - WONDER NEUTRALIZATION: ESOPHAGEAL STENTS IN CAUSTIC INJURY. Program No. P0323. ACG 2019 Annual Scientific Meeting Abstracts. San Antonio, Texas: American College of Gastroenterology.