Esophageal Obstruction Secondary to Erosion of an Angelchik ProsthesisThe Role of Endoscopic Management

Abstract

The Angelchik prosthesis had been considered a safe alternative for the surgical treatment of refractory GERD. The prosthesis consists of a ring-shaped silicone shell filled with vulcanized silicone gel (Fig. 1A). The prosthesis is implanted surgically around the distal esophagus at the gastroesophageal junction (GEJ). A radiopaque silicone marking strap allows for closure of the ring around the esophagus and later radiographic localization (Fig. 1B). The implantation procedure was intended to be shorter in duration and to rely less upon suturing of serosal layers than other surgical procedures, such as fundoplication and posterior gastropexy.1 The prosthesis was approved by the Food and Drug Administration in the United States in 1979 for use in humans, but its use was abandoned in the late 1980s because of frequent complications and high cost. There are few reported series evaluating long-term follow-up and safety of the Angelchik prosthesis. This report describes the first case in which an Angelchik prosthesis caused mechanical obstruction of the lumen after partially eroding through a portion of the esophageal wall lined by long-segment Barrett's esophagus. The prosthesis was removed successfully without surgery by endoscopic extraction. Previous reports that describe endoscopic management of this unique and rare complication are reviewed.