Endoscopic treatment of extreme esophageal stenosis complicated with esophagotracheal fistula: A case report

BACKGROUND At present,there is no unified and effective treatment for extreme corrosive esophageal stenosis(CES)with esophagotracheal fistula(ETF).This case had extreme and severe esophageal stenosis(ES)and ETF after ingesting an enzyme-based chemical detergent,resulting in a serious pulmonary infection and severe malnutrition.Upper gastrointestinal imaging showed that he had an ETF,and endoscopy showed that he had extreme and severe esophageal stricture.This case was complex and difficult to treat.According to the domestic and foreign lite-rature,there is no universal treatment that is low-risk.CASE SUMMARY A patient came to our hospital with extreme ES,an ETF,and severe malnutrition complicated with pulmonary tuberculosis 1 mo after the consumption of an enzy-me-based detergent.The ES was serious,and the endoscope was unable to pass through the esophagus.We treated him by endoscopic incision method(EIM),esophageal stent placement(ESP),and endoscopic balloon dilation(EBD)by using the bronchoscope and gastroscope.This treatment not only closed the ETF,but also expanded the esophagus,with minimal trauma,greatly reducing the pain of the patient.According to the literature,there are no similar reported cases.CONCLUSION We report,for the first time,a patient with extreme CES complicated with ETF,where the endoscope could not be passed through his esophagus but he could be examined by bronchoscopy and treated by EIM,ESP,and EBD.

Endoscopic magnetic compression stricturoplasty for congenital esophageal stenosis:A case report

BACKGROUND Congenital esophageal stenosis(CES)is a rare malformation of the digestive tract.Endoscopic dilation and thoracotomy have been the main treatments for CES.However,there is no well-defined management protocol.Magnetic compression stricturoplasty(MCS)has been used in refractory esophageal stricture in children after esophageal atresia.CASE SUMMARY We describe the first case of MCS for CES in one female child patient.The child(aged 3 years and 1 mo)was admitted due to frequent vomiting and choking after eating complementary food since 7 mo old.Esophagography and gastroendoscopy showed that there was stenosis in the lower esophagus,suggesting a diagnosis of CES.The patient did not receive any treatment for esophageal stricture including surgery or endoscopic dilation procedures before MCS.MCS procedure was smoothly conducted without complications.At 24 mo after MCS,durable esophageal patency without dysphagia was achieved.CONCLUSION MCS may serve as an alternative and efficient method for patients with CES.

Superior mesenteric artery syndrome in a patient with esophageal stenosis: A case report

BACKGROUND Superior mesenteric artery syndrome(SMAS)is a rare condition,characterized by duodenal obstruction caused by compression of its third part by the superior mesenteric artery(SMA).Most cases of SMAS are associated with weight loss,and the most frequent clinical manifestations are nausea,vomiting,postprandial fullness,and abdominal pain.Treatment of SMAS is usually conservative,consisting mainly of adequate nutritional support,but in refractory cases surgery may be necessary,with gastrojejunostomy and duodenojejunostomy being the most commonly performed procedures.CASE SUMMARY We describe the case of a man in his forties with a pre-existing diagnosis of esophageal stricture due to sodium hydroxide ingestion,who suffered significant weight loss after replacement of his jejunostomy tube.He was admitted to the hospital due to pain and abdominal distension.A computerized tomography scan showed significant distension of the stomach and duodenum with narrowing of the duodenum at the point at which it is crossed by the superior mesenteric artery,thus establishing the diagnosis of SMAS.Due to the presence of the esophageal stricture,the patient was incapable of emesis;however,passage of a nasogastric tube for decompression was not possible.Considering the risk of gastric perforation due to distention,we opted for surgical treatment in the form of a surgical gastrojejunostomy after which he showed complete resolution of all symptoms and was discharged from the hospital 5 d after the procedure.CONCLUSION Diagnosis of SMAS can be challenging in patients with esophageal stenosis,and risk of gastric perforation may preclude conservative treatment.

Prospects of polyglycolic acid sheets for the treatment of esophageal stricture after esophageal endoscopic submucosal dissection

Esophageal cancer is the seventh most common type of cancer and the sixth leading cause of cancer-related mortality worldwide.Endoscopic submucosal dissection(ESD)is widely used for the resection of early esophageal cancer.However,post-ESD esophageal stricture is a common long-term complication,which requires attention.Patients with post-ESD esophageal stricture often experience dysphagia and require multiple dilatations,which greatly affects their quality of life and increases healthcare costs.Therefore,to manage post-ESD esophageal stricture,researchers are actively exploring various strategies,such as pharmaceutical interventions,endoscopic balloon dilation,and esophageal stenting.Although steroids-based therapy has achieved some success,steroids can lead to complications such as osteoporosis and infection.Meanwhile,endoscopic balloon dilatation is effective in the short term,but is prone to recurrence and perforation.Additionally,esophageal stenting can alleviate the stricture,but is associated with discomfort during stenting and the complication of easy displacement also present challenges.Tissue engineering has evolved rapidly in recent years,and hydrogel materials have good biodegradability and biocompatibility.A novel type of polyglycolic acid(PGA)sheets has been found to be effective in preventing esophageal stricture after ESD,with the advantages of a simple operation and low complication rate.PGA membranes act as a biophysical barrier to cover the wound as well as facilitate the delivery of medications to promote wound repair and healing.However,there is still a lack of multicenter,large-sample randomized controlled clinical studies focused on the treatment of post-ESD esophageal strictures with PGA membrane,which will be a promising direction for future advancements in this field.

Follow-up study on symptom distress in esophageal cancer patients undergoing repeated dilation

BACKGROUND Repeated endoscopic probe dilatation is the most preferred treatment for esophageal stenosis which may cause high levels of symptom distress in the patient’s home rehabilitation stage.AIM To explore the changes in the symptom distress level and its correlation with the dilation effect in patients with esophageal carcinoma undergoing repeated dilations for lumen stenosis.METHODS The difference(R2-R1)between the diameter of the esophageal stenosis opening(R1)of the patients before dilation(R1)and after dilation(R2)was calculated to describe the extent and expansion of the esophageal stenosis before and after dilation.The M.D.Anderson Symptom Inventory was used to describe the symptom distress level of patients with dilation intermittence during their stay at home and to explore the correlation between the dilation effect and symptom distress level.RESULTS The diameter of the esophagus(R1)increased before each dilation in patients undergoing esophageal dilation(P<0.05).The diameter(R2)increased after dilation(P<0.05);the dilation effect(R2-R1)decreased with the number of dilations(P<0.05).The total symptom distress score significantly increased with the number of dilations(P<0.05).The symptom distress scores of the patients were negatively correlated(P<0.05)with the previous dilation effect(R2-R1)and the esophageal diameter(R2)after the previous dilation.After the 1 st to 4 th dilations,the patient’s symptom distress score was negatively correlated with the esophageal diameter(R12)before the next dilation,while there was no significant correlation(P>0.05)with the other dilations.CONCLUSION In patients who have undergone repeated dilations,better effect stands for lower symptom distress level and the increase in symptom distress has a prompt effect on the severity of the next occurrence of restenosis.

Managing esophagocutaneous fistula after secondary gastric pullup:A case report

BACKGROUND Gastric pull-up(GPU)procedures may be complicated by leaks,fistulas,or stenoses.These complications are usually managed by endoscopy,but in extreme cases multidisciplinary management including reoperation may be necessary.Here,we report a combined endoscopic and surgical approach to manage a failed secondary GPU procedure.CASE SUMMARY A 70-year-old male with treatment-refractory cervical esophagocutaneous fistula with stenotic remnant esophagus after secondary GPU was transferred to our tertiary hospital.Local and systemic infection originating from the infected fistula was resolved by endoscopy.Hence,elective esophageal reconstruction with freejejunal interposition was performed with no subsequent adverse events.CONCLUSION A multidisciplinary approach involving interventional endoscopists and surgeons successfully managed severe complications arising from a cervical esophagocutaneous fistula after GPU.Endoscopic treatment may have lowered the perioperative risk to promote primary wound healing after free-jejunal graft interposition.