Nassau University Medical Center East Meadow, NY, United States
Rucha Jiyani, MD1, Bobby Jacob, MD2, Jiten Desai, MD1, Shruti Patel, MD1, Zalak Desai, MD1, Santosh Kale, MD1, Kaleem Rizvon, MD1 1Nassau University Medical Center, East Meadow, NY; 2Nassau University Medical Center, Lake Grove, NY
Introduction: Benign esophageal strictures can result from long-standing GERD, ablative or radiation therapy, caustic ingestion and etc. Management of strictures could be very challenging. We describe a case of a refractory esophageal stricture with aim to focus on management challenges.
Case Description/Methods: A 36-year-old Indian female with a history of esophageal strictures secondary to caustic ingestion present to our GI clinic with complaints of worsening dysphagia to solids. She underwent multiple serial endoscopies with dilatation at an outside facility and subsequently was performing self-dilatation with bougie dilators, until no further relief of her symptoms. An esophagram revealed a narrow caliber mid and distal esophagus with 3 prominent stricture points. The proximal stricture could not be traversed on initial endoscopy with 9.9 mm gastroscope, therefore a 4.9 mm bronchoscope was used to assess the size and location of the 3 esophageal strictures which were noted at 25 cm, 30 cm and 35 cm from incisors. Serial dilations were performed with a CRE balloon dilator and triamcinolone injection at the refractory stricture site post dilation. The esophageal strictures were able to be dilated with serial dilatations and the gastroscope was able to traverse all 3 strictures without difficulty and patient experienced symptomatic relief. Patient was counseled regarding high risk of perforation with subsequent dilatation and given surgical consultations for second opinion and alternative management options.
Discussion: Late management of caustic strictures makes dilatation more complex owing to fibrosis in esophageal wall. Perforation rates for caustic strictures is higher than standard benign stricture dilatation with anything from 0.4 up to 32% recorded in the literature. Refractory strictures are more common in caustic ingestion and the management has been reported with intralesional steroid injection or topical mitomycin C at the time of dilatation, and temporary stent placement. Prior to dilatation one must consider the following prior to endoscopically dilating such as etiology of stricture, degree of patient’s dysphagia, length, tortuosity and luminal diameter of the stricture. Our patient’s strictures were refractory to dilatation and intralesional steroid use. Stent placement is technically not feasible given different size and diameter of strictures as it enhances risk of perforation. Surgery although a high-risk approach but remains as curative resort for such cases.
Rucha Jiyani indicated no relevant financial relationships.
Bobby Jacob indicated no relevant financial relationships.
Jiten Desai indicated no relevant financial relationships.
Shruti Patel indicated no relevant financial relationships.
Zalak Desai indicated no relevant financial relationships.
Santosh Kale indicated no relevant financial relationships.
Kaleem Rizvon indicated no relevant financial relationships.
Rucha Jiyani, MD1, Bobby Jacob, MD2, Jiten Desai, MD1, Shruti Patel, MD1, Zalak Desai, MD1, Santosh Kale, MD1, Kaleem Rizvon, MD1. P0374 - Refractory Benign Esophageal Stricture - Management Dilemma, ACG 2021 Annual Scientific Meeting Abstracts. Las Vegas, Nevada: American College of Gastroenterology.