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
ARTICLE HIGHLIGHTS
Research background

The ingestion of corrosives may lead to tight near-total strictures of the esophagus with concomitant involvement of the hypopharynx. This is an extremely challenging situation for the clinicians and there are limited treatment options for addressing such complex strictures.

Research motivation

The only viable management option for complex hypopharyngo-esophageal strictures is surgery. However, surgical interventions are associated with high morbidity and mortality. Moreover, patients may even be unfit for undergoing surgery due to extreme malnutrition. Because of these reasons, many patients ultimately succumb to their illness. The development of minimally invasive endoscopic techniques would be a highly desirable step to salvage this subset of patients.

Research objectives

In this study, we evaluated a novel flexible endoscopic technique for the management of tight near-total corrosive strictures of the esophagus with concomitant involvement of the hypopharynx.

Research methods

Two patients with near-total hypopharyngo-esophageal strictures were managed by the novel technique, under conscious sedation. A flexible 0.025-inch guide-wire was passed across the stricture, followed by dilatation of the stricture with a 10F coaxial diathermy and balloon dilators. The residual eccentric stricture was electroincised by a novel approach, using a wire-guided sphincterotome.

Research results

Both patients were successfully managed on an OPD basis with the complete relief of symptoms and resolution of strictures on endoscopy and an esophagogram. No complication was seen during or after the procedure. In the follow-up, patients remained symptom-free, along with a significant improvement in the body mass index.

Research conclusions

The complex hypopharyngo-esophageal strictures were successfully opened up with the novel flexible endoscopic technique, without any complications.

Research perspectives

We report a novel minimally invasive flexible endoscopic technique for addressing the tight near-total hypopharyngo-esophageal strictures. The technique is relatively simple, safe and effective with a durable response. But larger studies are required to validate the efficacy and safety of the technique across different endoscopic set-ups.