3094 Esophageal Strictures After Ingestion of Picosulfate Powder for Colonoscopy

Abstract

INTRODUCTION: Picosulfate solution is widely used as a small volume bowel cleansing agent considered to be effective and relatively safe. CASE DESCRIPTION/METHODS: A 75 - year - old woman came to our hospital with severe neck pain that occurs when she swallows food. A week before our hospital visiting, she had scheduled the EGD and colonoscopy for a health checkup. At the time of EGD, there was white exudates and hemorrhagic spots in the esophagus. But, she had any pain at that time. After 1 week she felt a severe sore throat, visited otolaryngologist, but she was told there was nothing wrong. Despite of medication, she continued to suffer severe pain and she came to our emergency room and received otolaryngologist consultation. However, she was told that she had no particular abnormal findings. She underwent an EGD to examine the cause of the neck pain. The EGD showed multiple superficial ulcers and yellowish exudates throughout the esophagus (Figure 1). We had a biopsy in the esophagus. The result was candidiasis. One week later, she had difficulty in swallowing, and she had another EGD. The esophageal lumen was narrowed at the position of upper incisor (UI) 20 ∼ 30 cm and multiple ulcers were scattered and the endoscope could not pass to the distal side of the esophagus (Figure 2). We investigated her medication history to find out why she had the esophageal strictures. She was being treated for diabetes and atrial fibrillation 20 years ago, and we found she had taken picosulfate powder for colonoscopy a week ago. She mistakenly took the picosulfate powder first, drank the water later. She felt a little uncomfortable with the epigastric area, but she thought it was nothing. During her hospital stay, she was treated conservatively, including fasting, antibiotics, and parenteral nutritional support. After her symptoms improved, she was discharged. About a month later, she came to the outpatient clinic because of dysphagia for solid food. EGD showed esophageal stricture at UI 25 cm and passed through the site using a ultrathin scope. The narrowed area of the UI 30 cm was not able to pass through the endoscope (Figure 3). Using a guide wire, a 10 cm full covered metal stent was inserted through the scope. DISCUSSION: We reported a case of esophageal ulcer and stricture caused by a picosulfate power that the patient took accidentally. When picosulfate powder is used as a bowel cleansing agent, patient should be educated to take after dissolving it more than 200 mL of water to avoid esophageal injury.