Endoscopy 2018; 50(04): S125
DOI: 10.1055/s-0038-1637402
ESGE Days 2018 ePoster Podium presentations
21.04.2018 – EUS Interventional: extreme
Georg Thieme Verlag KG Stuttgart · New York

EUS GUIDED RECANALIZATION OF COMPLETE OESOPHAGEAL STRICTURE

C Mangas
1   Hospital General Universitario de Alicante, Endoscopy Unit, Alicante, Spain
,
J Martínez
1   Hospital General Universitario de Alicante, Endoscopy Unit, Alicante, Spain
,
L Compañy
1   Hospital General Universitario de Alicante, Endoscopy Unit, Alicante, Spain
,
FA Ruíz
1   Hospital General Universitario de Alicante, Endoscopy Unit, Alicante, Spain
,
JA Casellas
1   Hospital General Universitario de Alicante, Endoscopy Unit, Alicante, Spain
,
J Ramón Aparicio
1   Hospital General Universitario de Alicante, Endoscopy Unit, Alicante, Spain
› Author Affiliations
Further Information

Publication History

Publication Date:
27 March 2018 (online)

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Aim:

Endoscopic treatment of complete oesophageal strictures is sometimes difficult. However, if the distance between the proximal and the distal end of the stricture is short, it's possible to recanalize the esophagus by direct wire-guided puncture under transillumination. If it's not possible, endoscopy ultrasound (EUS) might be a useful tool. The aim was to use EUS to localize the distal end of a stenosis located in the esophagus.

Methods:

A 74 years-old man was diagnosed with T3 – 4N1M0 epidermoid carcinoma of hypopharynx. He received chemotherapy (CDDP-3 cycles) and intensity modulated radiotherapy (70 Gy). He had a percutaneous endoscopic gastrostomy (PEG) and because of radiotherapy had a complete stricture localized in the proximal esophagus. After finishing oncological treatment, oncologists asked for an endoscopic oeshophageal dilatation.

Results:

The patient went under an upper gastrointestinal endoscopy, and a complete stricture in the proximal esophagus, next to the Killian's mouth, was found. Then, a pediatric endoscope was used at the same time through the PEG. Under transillumination, a guidewire was used to pass the stricture, but couldn't reach the hypopharynx. Afterwards, the guidewire was left in the distal esophagus, and an extractor catheter dilatation balloon trough the PEG was used and physiological serum was instilled into the lumen. The light was identified by EUS located in the hypopharynx. We used a 19G needle to puncture and a 0.025” guidewire passed to the distal esophagus. 6 mm wire-guided balloon dilatation was used, so a nasojejunal tube was placed to keep the passage permeable.

After that, the patient went under 12 sessions of oesophageal Savary dilatation until 16 mm were reached. Then, he started to feed normally, gained weight so the PEG was removed. After 6 months, the patient is still asymptomatic.

Conclusion:

In cases of complete strictures of the esophagus, EUS can identify the distal lumen and facilitates lumen recanalization.