Esophageal stricture is a narrowing of the esophageal lumen, often causing esophageal
obstruction [1]
[2]. Dilation of strictures by endoscopy using balloon dilation is indicated to restore
the patency of the esophageal lumen [3]. We present the case of a 55-year-old Japanese man who presented with chest discomfort.
Upper gastrointestinal endoscopy (UGE) revealed a full-circumferential ulcer in the
mid-portion of the esophagus, without obvious dysmorphic epithelium ([Fig. 1]). In the absence of obvious malignancy on biopsy, proton pump inhibitors (PPI) were
prescribed for severe reflex esophagitis. On day 36 of PPI treatment, the patient
reported aggravation of esophageal stasis with solid food. On UGE, an esophageal stricture
was observed and was treated by endoscopic esophageal dilatation (EED) using a 12-mm-diameter
balloon (CRE PRO GI Wireguided Balloon; Boston Scientific, USA). EED needed to be
repeated 2 weeks later. On this second occasion, the stricture was assessed using
an ordinary 9.8-mm-diameter upper gastrointestinal endoscope (EG-840T; Fujifilm, Japan),
as used on the previous occasion. The endoscope could not be passed through the region
of stricture due to scarring in the area of the ulcer ([Fig. 2]). Therefore, we selected to use a narrow-diameter, 7.9-mm upper gastrointestinal
endoscope (EG-840TP; Fujifilm). Although the narrow-diameter endoscope could not be
passed through the region of stenosis, it could be safely inserted into the esophageal
inlet, providing a more detailed assessment of the stricture compared to the 9.8-mm
diameter endoscope. The narrow-diameter endoscope includes a 3.2-mm hole for endoscopic
forceps, which allowed us to perform EED using a 13.5-mm-diameter balloon (CRE PRO
GI Wireguided Balloon) without difficulty ([Fig. 3]; [Video 1]). After EED, the endoscope could be passed through the region of stenosis without
resistance. Based on our experience, we propose that the novel narrow-diameter endoscope
is a potential first-choice endoscope for safe and reliable EED.
Fig. 1 Initial upper gastrointestinal endoscopy showing a full-circumferential ulcer in the
mid-portion of the esophagus, with no evidence of obvious dysmorphic epithelium. a Longitudinal ulcer observed at the oral edge of the esophageal ulcer. b Circumferential esophageal ulcers are visible.
Fig. 2 Images of the second endoscopic esophageal dilatation (EED) procedure. A 9.8-mm upper
gastrointestinal endoscope was first used to assess the esophageal stricture (EG-840T,
9.8 mm, Fujifilm, Japan). a White light imaging; b blue laser imaging.
Fig. 3
a, b The 9.8-mm upper gastrointestinal endoscope could not be
passed safely through any region of the stenosis and was therefore exchanged for one
of a
narrower diameter that could pass through the esophageal inlet in order to further
evaluate
the stricture. c, d EED was subsequently performed without
difficulty using the narrow endoscope with a 13.5-mm diameter balloon.
A novel narrow-diameter endoscope was useful for performing endoscopic balloon dilation
of an esophageal stricture.Video 1
Endoscopy_UCTN_Code_TTT_1AO_2AH
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