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• W2913742001 abstract "Benign esophageal strictures (ES) typically occur as a result of gastroesophageal reflux, radiation fibrosis, and caustic injury. Simple strictures are short and straight, whereas complex strictures are normally greater than 2 cm in length, irregular, or have a markedly small diameter. Treatment of benign ES includes endoscopic balloon dilation. Here, we present a case of a patient with benign ES that was complicated by esophageal perforation. A 25-year-old female presented with a 9-month history of dysphagia, vomiting, and weight loss. She reported a history of ES for which she underwent endoscopic balloon dilation in her home country of Ecuador that was complicated by esophageal perforation with subsequent esophageal surgery and J-tube placement. Examination was notable for a HR of 43 bpm, BP of 91/57 mmHg, cachexia, dry mucous membranes, and J-tube without signs of infection. ECG showed sinus bradycardia. Hepatitis, HIV, and tuberculosis testing were negative. Echocardiogram was normal with an estimated EF of 65%. An endoscopy was performed and the scope was unable to be passed beyond the gastroesophageal junction due to high-grade stenosis. Findings showed stenosis 30 cm from the incisors with a luminal diameter of about 1mm (Figure 1). Biopsies confirmed esophageal candidiasis without evidence of malignancy or eosinophilic esophagitis. The patient was treated for malnutrition and esophageal candidiasis. She subsequently underwent weekly endoscopic balloon dilation therapy. Biopsies showed moderately severe erosive esophagitis, gastritis, and were positive for H. pylori. She was started on triple-therapy to treat H. pylori infection. Ultimately, the ES was dilated to 12mm and fully covered with an esophageal stent (Figure 2). She was scheduled for repeat endoscopy for stent removal. The advent of newer fully covered self-expanding metal stents have a thin, flexible delivery catheter that is easily deployed within the esophagus. Some studies have reported a significant improvement in symptomatology, however complications such as stent migration occurred in 26% of patients. The purpose of this case is to highlight the current management and treatment options of benign esophageal strictures. Our patient's clinical course was unusual in that it was complicated by esophageal perforation, an infrequently encountered problem. Large, randomized-controlled trials are necessary to further evaluate the efficacy of stents in the management of esophageal stricture.Figure: Upper endoscopy showing severe esophageal stenosis. The lumen of the upper- and middle-third of the esophagus was mildly dilated. There were a few tiny punctate nummular lesions in the middle and lower third of the esophagus, consistent with candidiasis.Figure: Benign appearing esophageal stenosis dilated to 12mm. Fully covered esophageal stent (Wallflex 18 mm x 10.3 cm) placed successfully." @default.
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• W2913742001 date "2017-10-01" @default.
• W2913742001 modified "2023-09-27" @default.
• W2913742001 title "Endoscopic Management of Benign Esophageal Stricture of Multifactorial Etiology Complicated by Esophageal Perforation" @default.
• W2913742001 doi "https://doi.org/10.14309/00000434-201710001-01738" @default.
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