Case Report
Copyright ©The Author(s) 2018. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Endosc. Nov 16, 2018; 10(11): 367-377
Published online Nov 16, 2018. doi: 10.4253/wjge.v10.i11.367
Tight near-total corrosive strictures of the proximal esophagus with concomitant involvement of the hypopharynx: Flexible endoscopic management using a novel technique
Harpal S Dhaliwal, Nitin Kumar, Pradeep Kumar Siddappa, Ripudaman Singh, Jogeet Singh Sekhon, Jaspal Masih, Justin Abraham, Sameer Garg
Harpal S Dhaliwal, Ripudaman Singh, Jogeet Singh Sekhon, Jaspal Masih, Justin Abraham, Department of Gastroenterology, Christian Medical College and Hospital, Ludhiana 141012, Punjab, India
Nitin Kumar, Department of Internal Medicine, Christian Medical College and Hospital, Ludhiana 140012, Punjab, India
Pradeep Kumar Siddappa, Department of Internal Medicine, University of Connecticut, Farmington 06269, United States
Sameer Garg, Department of Radiodiagnosis and Imaging, Fortis Hospital, Ludhiana 140012, Punjab, India
Author contributions: Dhaliwal HS designed and performed the research, reviewed the literature and wrote the paper; Kumar N, Siddappa PK and Garg S critically reviewed the paper for intellectual content; Singh R, Sekhon JS, Masih J and Abraham J collected the data.
Informed consent statement: Informed consent was obtained prior to the procedure from the included patients.
Conflict-of-interest statement: We, all authors, declare no conflict of interest relevant to this work.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Harpal S Dhaliwal, MD, Assistant Professor, Department of Gastroenterology, Christian Medical College and Hospital, Brown Road, Ludhiana 141012, Punjab, India. hsdhaliwalpgi@yahoo.com
Telephone: +91-991-4207363
Received: August 6, 2018
Peer-review started: August 7, 2018
First decision: August 24, 2018
Revised: September 26, 2018
Accepted: October 6, 2018
Article in press: October 7, 2018
Published online: November 16, 2018
Processing time: 102 Days and 18.2 Hours
Abstract
AIM

To investigate the role of a novel minimally invasive endoscopic technique in the management of tight near-total corrosive strictures of the proximal esophagus involving the hypopharynx.

METHODS

Two patients with near-total corrosive strictures of the proximal esophagus involving the hypopharynx were managed with the novel endoscopic technique. The technique involved passing a 0.025-inch flexible guide-wire across the stricture, and stricture dilatation, using 10F coaxial diathermy and balloon dilators, followed by electro-incision of the proximal aspect of the residual eccentric stricture by means of a novel approach using a wire-guided sphincterotome.

RESULTS

Both patients were successfully managed on an outpatient department basis with the complete relief of symptoms and resolution of strictures on endoscopy and an esophagogram. No adverse events were seen during or after the procedure. There was no recurrence of symptoms at a follow-up of over a year in both cases. There was a significant improvement in the body mass index of both patients after the procedure.

CONCLUSION

We report a novel flexible endoscopic technique for the management of complex hypopharyngo-esophageal strictures. In experienced hands, the procedure is relatively simple, safe and effective with a durable response.

Keywords: Cricopharyngeal strictures; Electroincision; Corrosive injury; Benign esophageal strictures; Stricture dilatation

Core tip: In this study, we evaluated the minimally invasive endoscopic management of near-total benign fibrotic strictures of the proximal esophagus involving the hypopharynx across the pharyngo-esophageal junction. Both patients were successfully treated using a novel approach: stricture dilatation (with a 10F co-axial diathermic dilator and through-the-scope balloon) followed by the electroincision of residual adhesions at the hypopharyngeal base with a wire-guided sphincterotome. To the best of our knowledge, this report represents the tightest esophageal or hypopharyngeal strictures ever opened endoscopically and reported in the literature.