Esophageal Mucosal Bridge In Young Male With Radiation Esophagitis Presidential Poster

Abstract

Figure: No Caption available.Purpose: An esophageal mucosal bridge is a rarely encountered entity in endoscopy. It is thought to be a result of mucosal healing across previous areas of inflammation. Previous reports of mucosal bridges have been seen in patients with reflux esophagitis, HIV/AIDS, candidiasis, tuberculosis, Crohn's disease, lupus and nasogastric tube injury. To our knowledge, this is the first reported case of an esophageal mucosal bridge seen in the setting of radiation esophagitis. A 21-yearold male with a history of Ewing's sarcoma of the spine who had completed external beam radiation therapy and was currently receiving adjuvant chemotherapy was seen in the endoscopy suite for scheduled repeat therapeutic esophageal dilation. He had developed dysphagia and odynophagia with weight loss which persisted for months following completion of his radiation therapy. He had undergone TTS balloon dilation two weeks before his presentation. He presented with symptoms of worsening dysphagia and odynophagia which he had prior to his initial dilation. Esophagogastroduodenoscopy (EGD) was performed and showed a stricture 27 cm from the incisors approximately 7-8 mm in diameter. This could only be traversed with an ultra-slim scope. At 29 cm there was a bridge of mucosa extending across the lumen of the esophagus creating the appearance of a double lumen. There was esophagitis in the adjacent mucosa. The bridge was approximately 1 cm in depth. The mucosal bridge was dissected with argon plasma coagulation (APC) utilizing a bronchoscopic APC cannula at 0.3 liters/minute and 20 watts at the point of minimal tissue diameter. The bases of the bridge were then injected with 5 mL of saline mixed with 1 mL of 40 mg/mL triamcinolone in an attempt to reduce recurrence. The proximal stricture was then dilated up to 11 mm. The patient's odynophagia and dysphagia improved, and he returned for repeat elective EGD 3 weeks days later. The bridge had resolved and the previously noted stricture was again dilated. Esophageal mucosal bridges are rarely reported in the medical literature. Our limited experience suggests that these lesions can be successfully treated with APC followed by steroid injection at the bases. Other authors have reported success with this method as well.