Rochester General Hospital Rochester, NY, United States
Ashish Gandhi, MD1, Harshal Gadhikar, MD2, Jay Bapaye, MD3 1Shivanand Desai Center of Digestive Diseases, Pune, Maharashtra, India; 2Deenanath Mangeshkar Hospital, Pune, Maharashtra, India; 3Rochester General Hospital, Rochester, NY
Introduction: Pharyngeal strictures are usually secondary to corrosive injury. Management can be technically challenging and traditionally involves laser assisted ablation or surgical intervention. We report a case of endoscopic stricturotomy using electroincision for successful management of pharyngeal stricture secondary to accidental hanging.
Case Description/Methods: A 38 year old male patient with rural background – accidental hanging in recent past – surgical repair for neck injury 3 months back (exact surgical details not available) and able to take regular meals post-surgery – now symptomatic over 1 month duration – presenting with dysphagia, nasal regurgitation, post prandial cough and weight loss. Endoscopy was performed under propofol sedation and head low position. Pre-emptive endotracheal intubation was deferred for better scope maneuverability – however, emergency bronchoscopy guided nasal intubation apparatus and tracheostomy related apparatus was kept on standby. Endoscopy revealed pharyngeal stricture distal to epiglottis and proximal to laryngeal apparatus. Regular adult gastroscope was not negotiable. Endoscopic stricturotomy using electroincision was performed using insulated tip knife (IT Knife-2) in ENDOCUT I mode following which endoscope was negotiable. At 2 - week follow up, stricture remodelled – regular adult gastroscope negotiable without resistance into the esophagus. At 3 - month follow up, no symptom recurrence seen.
Discussion: Pharyngeal stricture management in our case was challenging - endoscopic balloon dilatation / stenting was not feasible as anatomy was not suitable. Additionally there was risk of laryngeal injury as balloon dilatation would have been a blind procedure. Surgical intervention would have been morbid for the patient. Stricturotomy allowed precise cut w.r.t location and depth and was performed under direct endoscopic vision. No symptom recurrence was seen at 3-month follow up.
This case video demonstrates successful endoscopic stricturotomy using electroincision for management of pharyngeal stricture with good short term efficacy.
Disclosures: Ashish Gandhi indicated no relevant financial relationships. Harshal Gadhikar indicated no relevant financial relationships. Jay Bapaye indicated no relevant financial relationships.
Ashish Gandhi, MD1, Harshal Gadhikar, MD2, Jay Bapaye, MD3. P1757 - Endoscopic Stricturotomy Using Electroincision for Successful Management of Secondary Pharyngeal Stricture Following Accidental Hanging, ACG 2021 Annual Scientific Meeting Abstracts. Las Vegas, Nevada: American College of Gastroenterology.