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Incision therapy for an unusual esophageal stricture
VIDEOGIE Todd H. Baron, MD, G. S. Raju, MD, Editors for VideoGIE
Incision therapy for an unusual esophageal stricture
Figure 1. Esophageal stricture after needle knife incision therapy.
2015 WORLD CUP OF ENDOSCOPY WINNER Benign esophageal strictures are most commonly related to prolonged GERD, iatrogenic causes (eg, anastomotic, radiotherapy related, postendoscopic resection), or caustic ingestion. Standard dilation techniques are usually effective in achieving stricture resolution; however, advanced intervention may be required in refractory cases. We report a patient with progressive, severe dysphagia. He previously had a prolonged hospitalization for typhoid, during which time he had significant odynophagia. A tight, benign esophageal stricture refractory to standard dilation techniques was present. No other cause of his dysphagia was identified. Multifocal typhoid-related esophageal stricturing was diagnosed. Needle-knife incision therapy was performed (Video 1, available online at www.giejournal. org). A series of linear incisions, perpendicular to the esophageal wall, were made with a needle-knife. The depth of incision was determined by using the esophageal wall distal to the stricture as the critical landmark (Fig. 1). Needle-knife incision therapy has mainly been described in postanastomotic strictures. The risk or perforation has been reported as being low (1%-2%), but rates of
www.giejournal.org
restenosis of up to 50% are seen. Needle-knife incision therapy is a useful technique to treat benign esophageal strictures refractory to standard therapy. Typhoid is a rare cause of esophageal stricture formation but should be considered in the appropriate clinical context.
DISCLOSURE All authors disclosed no financial relationships relevant to this publication. Milan S. Bassan, MBBS, FRACP, Department of Gastroenterology and Hepatology, Liverpool Hospital, Liverpool, Australia, University of New South Wales, Sydney, Australia, Mohit Shetti, MBBS, FRACP, Paul Edwards, MD, FRACP, David Abi-Hanna, MBBS, FRACP, Department of Gastroenterology and Hepatology, Liverpool Hospital, Liverpool, Australia, Jenn Koo, MBBS, FRACP, Department of Gastroenterology and Hepatology, Liverpool Hospital, Liverpool, Australia, University of New South Wales, Sydney, Australia http://dx.doi.org/10.1016/j.gie.2015.08.015
Volume
-,
No.
-
: 2015 GASTROINTESTINAL ENDOSCOPY 1
Incision therapy for an unusual esophageal stricture
Figure 1. Esophageal stricture after needle knife incision therapy.
2015 WORLD CUP OF ENDOSCOPY WINNER Benign esophageal strictures are most commonly related to prolonged GERD, iatrogenic causes (eg, anastomotic, radiotherapy related, postendoscopic resection), or caustic ingestion. Standard dilation techniques are usually effective in achieving stricture resolution; however, advanced intervention may be required in refractory cases. We report a patient with progressive, severe dysphagia. He previously had a prolonged hospitalization for typhoid, during which time he had significant odynophagia. A tight, benign esophageal stricture refractory to standard dilation techniques was present. No other cause of his dysphagia was identified. Multifocal typhoid-related esophageal stricturing was diagnosed. Needle-knife incision therapy was performed (Video 1, available online at www.giejournal. org). A series of linear incisions, perpendicular to the esophageal wall, were made with a needle-knife. The depth of incision was determined by using the esophageal wall distal to the stricture as the critical landmark (Fig. 1). Needle-knife incision therapy has mainly been described in postanastomotic strictures. The risk or perforation has been reported as being low (1%-2%), but rates of
www.giejournal.org
restenosis of up to 50% are seen. Needle-knife incision therapy is a useful technique to treat benign esophageal strictures refractory to standard therapy. Typhoid is a rare cause of esophageal stricture formation but should be considered in the appropriate clinical context.
DISCLOSURE All authors disclosed no financial relationships relevant to this publication. Milan S. Bassan, MBBS, FRACP, Department of Gastroenterology and Hepatology, Liverpool Hospital, Liverpool, Australia, University of New South Wales, Sydney, Australia, Mohit Shetti, MBBS, FRACP, Paul Edwards, MD, FRACP, David Abi-Hanna, MBBS, FRACP, Department of Gastroenterology and Hepatology, Liverpool Hospital, Liverpool, Australia, Jenn Koo, MBBS, FRACP, Department of Gastroenterology and Hepatology, Liverpool Hospital, Liverpool, Australia, University of New South Wales, Sydney, Australia http://dx.doi.org/10.1016/j.gie.2015.08.015
Volume
-,
No.
-
: 2015 GASTROINTESTINAL ENDOSCOPY 1