3115 Bronchoscope in the Esophagus?! A Novel Technique for Esophageal Strictures Management

Abstract

INTRODUCTION: Benign esophageal strictures can result from long-standing GERD, ablative or radiation therapy, corrosive substance ingestion etc. Management of strictures could be very challenging. We describe a case of esophageal strictures that was managed with an innovative approach. CASE DESCRIPTION/METHODS: A 36-year-old Indian female with a history of esophageal strictures secondary to caustic ingestion 9 years ago presented with complaints of dysphagia. Patient underwent multiple EGD with dilatations in the early years of her stricture formation. Subsequently she was taught to perform self dilations in India, every 2 weeks to relieve dysphagia. An esophagram revealed a narrow caliber mid and distal esophagus with 3 prominent stricture points. During endoscopy an 8.8 mm gastroscope could not traverse the most proximal stricture hence a bronchoscope was used to evaluate the number and size of strictures for optimal use of pneumatic balloon catheter for dilation. The bronchoscope evaluation revealed 3 esophageal strictures at 25 cm, 30 cm and 35 cm from incisors. Serial dilations were performed with a balloon dilator and triamcinolone was then injected at the stricture site post dilation. Following this intervention she was able to defer dilatation for 6 weeks. Using a Bronchoscope a second session of dilatation and triamcinolone injection was repeated 6 weeks later. Therapy was required for one of the three strictures with the others having healed well. Patient has not been performing self dilations since her first EGD and continues to be asymptomatic. DISCUSSION: Caustic ingestion and its gastrointestinal sequelae such as stricture formation have been an important public health concern for decades. Damage and complications depend on several aspects: substance concentration and pH, length of time of tissue contact and amount ingested. The primary treatment of a caustic esophageal stricture is endoscopic dilatation, however sometimes management could be challenging. Using a bronchoscope (thin caliber scope), the high grade strictures in our patient were traversed and evaluated optimally prior to execution of the treatment modality. In our extensive literature review, a bronchoscope has never been used before for managing high-grade strictures, which makes our case unique. We believe that this new technique of utilizing a bronchoscope for evaluation of high-grade strictures can provide more targeted therapeutic approach and superior management to the patient.