Complete Esophageal Obstruction Research Articles

Sporadic gastrinoma with refractory benign esophageal stricture: A case report

BACKGROUND Gastrinoma is characterized by an excessive release of gastrin, leading to hypersecretion of gastric acid, subsequently resulting in recurrent peptic ulcers, chronic diarrhea, and even esophageal strictures. This case report aims to improve awareness and facilitate early diagnosis and treatment of gastrinoma by presenting a rare case of gastrinoma with refractory benign esophageal stricture (RBES). Additionally, it highlights the persistent challenges that gastroenterologists encounter in managing RBES. CASE SUMMARY This case demonstrates a patient with gastrinoma who developed RBES and complete esophageal obstruction despite management with maximal acid suppressive therapy, multiple endoscopic bougie dilations and endoscopic incisional therapy (EIT). CONCLUSION It is essential to diagnose gastrinoma as early as possible, as inadequately controlled acid secretion over an extended period increases the risk of developing severe esophageal strictures. In patients with esophageal strictures causing complete luminal obstruction, blind reopening EIT presents challenges and carries a high risk of perforation.

Endoscopic Extraction of an Unusual Foreign Body at the Somine Dolo Hospital in Mopti

The esophagus is the most common site of impaction of an ingested foreign body. The main initial symptom is acute dysphagia; Patients with complete esophageal obstruction produce excessive amounts of saliva and are unable to swallow oral secretions. Complete obstruction can cause pressure necrosis and increases the risk of perforation if present for more than approximately 24 hours. Emergency endoscopy is necessary for sharp objects, disc or button batteries, and any obstruction causing symptoms that suggest complete obstruction. We report through this observation the extraction of an unusual esophageal foreign body at the Sominé Dolo hospital in Mopti. This was a 60-year-old patient, a farmer, with no known medical or surgical history to date, and no particular psychiatric disorder. The accidentally ingested foreign body was a cap from a recycled vinegar bottle. An attempt at extraction in the ENT department was made without success, then subsequently sent to the Hepato-gastroenterology unit. The endoscopic extraction of the foreign body was carried out without incident and the evolution was favorable after the endoscopy procedure.

S2817 Oh Nose! A Dislodged Nasal Trumpet Causing Complete Esophageal Obstruction

S2817 Oh Nose! A Dislodged Nasal Trumpet Causing Complete Esophageal Obstruction

Surgical management of complete esophageal obstruction in graded Murrah buffalo (Bubalus bubalis) - A case report

A seven-year-old, advance pregnant graded Murrah buffalo was presented with sudden onset of profuse salivation, anorexia, severe tympany and generalized discomfort. Palpation revealed enlarged cervical esophageal mass with pain and gagging reflex. Plain lateral radiography of neck showed presence obstructed mass in cervical esophageal lumen. The obstructed mass was removed via esophagotomy under deep sedation and local infiltration anaesthesia with uneventful recovery.

An unusual complication after variceal band ligation: complete esophageal obstruction, a case report and review of the literature

An unusual complication after variceal band ligation: complete esophageal obstruction, a case report and review of the literature

S357 Presidential Poster Award Mushroom Sign: Complete Esophageal Obstruction Following Endoscopic Variceal Band Ligation

Introduction: Gastrointestinal hemorrhage secondary to esophageal varices is frequently encountered by gastroenterologists. Endoscopic variceal band ligation is a procedure that has potential for complications. However complete esophageal obstruction due to band ligation is very uncommon. Case Description/Methods: An 80-year-old female patient transferred to our hospital with complaints of inability to tolerate oral secretions and chest discomfort. 24 hours prior to transfer, she underwent endoscopic variceal band ligation and three bands placed for primary prophylaxis. CT chest showed esophagus was dilated with fluid retention. and there was 1cm mass-like lesion in distal esophagus. Upper endoscopy was performed and revealed a mushroom-like appearance of mucosa in mid-esophagus, with a full circumferential banding of the esophagus lumen causing complete esophageal obstruction. Underlying band was seen. Following initial endoscopic exam, we discussed risk and benefits of band removal. Hepatology and interventional radiology were consulted and patient was consented for a possible need for transjugular intrahepatic portosystemic shunt placement as a rescue therapy in case of an acute variceal bleeding following endoscopic intervention. Repeat endoscopy was performed using the distal attachment cap, and band was grabbed with loop cutter, and gentle pulling pressure applied resulting removal of the band uneventfully (d). Subsequent endoscopic examination showed esophageal mucosa had circumferential mushroom-like edematous mucosa with ulcerated base in 10 mm length at 30 cm from incisors (e). Due to ongoing obstruction, we performed balloon dilation (8-10mm) to prevent further stricture formation and open the esophagus lumen (f). There was no post-procedure bleeding and scope was easily traversed the stenosis. Patient recovered well post-procedure and discharged home next day. A week later, patient had ongoing dysphagia and repeat endoscopy was scheduled for dilation. Discussion: Complete esophageal obstruction from variceal band ligation is very rare. Cases with partial obstruction or patients who can handle secretions can be managed with supportive care. In this case, we removed the band with loop cutter as this was a complete obstruction and patient was at risk for aspiration and airway compromise. This case should illustrate the importance of spiral banding technique and aiming towards one column of varices at a time. Practicing gastroenterologists and trainees should be aware of this rare complication. Watch the video at https://tinyurl.com/ACGAbstractS357

S2290 Complete Esophageal Obstruction: A Rare Complication of Zollinger-Ellison Syndrome (ZES)

Introduction: Patients diagnosed with ZES typically have minimal esophageal morbidity given advancements in anti-secretory medications. This case presents a rarely documented sequala of modern-day patients with ZES. Case Description/Methods: A 73-year-old man with history of HIV on HAART and ZES presented with worsening dysphagia to both solids and liquids. In the 2 year interval since his original presentation, his medical therapy was quickly maximized to omeprazole 180 mg/day and famotidine 80 mg/day. He also underwent tumor resection with distal gastrectomy, resection of D1, roux-en-Y hepaticojejunostomy, and truncal vagotomy. During that time his gastrin levels normalized from 1941 to 87. Despite these measures, he had undergone 21 EGDs and 7 esophageal stents for dysphagia secondary to refractory esophageal strictures. He lost 48 lbs over 2 years despite extensive attempts at both enteral and total parental nutrition. In January 2022, he presented with inability to swallow his own secretions and profound weakness from malnutrition. An esophagram was performed (figure 1a) revealing complete esophageal obstruction. An EGD with esophageal lumen restoration was attempted using combined retrograde and anterograde recanalization with 2 operators, 2 EGD scopes, and an EUS needle (figure 1c). Unfortunately, the 2 blind loops appeared to be approximately 6 cm apart in different alignments making lumen restoration unfeasible. The patient was most recently evaluated for esophageal reconstruction by jejunal interposition but was not a candidate due to poor nutritional status. Discussion: ZES is characterized by severe ulcerative disease due to gastric acid hypersecretion via neuroendocrine tumors. Our case is unique because this patient developed complete esophageal obstruction (CEO) despite management with maximal acid suppressive therapy, surgical resection, multiple EGDs with dilations, and numerous esophageal stents. CEO is a rare occurrence characterized by lumen obliteration leading to the inability to tolerate own secretions and most recorded cases are due to radiation-therapy for treatment of head and neck cancers. Given the low incidence, there is no single established method for endoscopic lumen restoration. However recombined retrograde and anterograde recanalization and dilation (CARD) has been shown to be successful for strictures less than 3 cm.Figure 1.: (A) Barium swallow study revealing a high-grade stricture in mid thoracic esophagus followed by another high-grade stricture with complete lumen obstruction. (B) EGD showing blind pouch approximately 35 cm from incisors. (C) Fluoroscopic imaging displaying attempt at combined anterograde and retrograde decannulation and dilation.

S2291 Complete Esophageal Obstruction Secondary to Variceal Banding

S2291 Complete Esophageal Obstruction Secondary to Variceal Banding

S2388 Time for a Rendezvous: Multi-Disciplinary Management of Complete Esophageal Obstruction in a Patient Following Radiation to Post-Surgical Anatomy

S2388 Time for a Rendezvous: Multi-Disciplinary Management of Complete Esophageal Obstruction in a Patient Following Radiation to Post-Surgical Anatomy

S2348 Novel Approach to Proximal Esophageal Stricture

Introduction: We present you a case of Stricture-induced severe dysphagia that was discovered to be caused by ulceration secondary to very proximal Zenker’s diverticulum (ZD). This case report also describes a novel approach to esophageal endoscopy through a retrograde approach. Case Description/Methods: Patient is an 80 y/o African American female with a past medical history of Gastroesophageal Reflux disease, Congestive Heart Failure, Chronic Kidney disease and Dementia who presented with Heart failure exacerbation. Patient reported weight loss and dysphagia to solid food and liquids for about 2 months. Patient then underwent a modified barium swallow study (MBSS), which showed concerns for esophageal stricture and evidence that the contrast material was not passing through the esophagus. Patient then underwent Esophagogastroduodenoscopy (EGD), which showed complete esophageal obstruction approximately 25 cm from the incisors and impacted food. The food was removed and a repeat EGD was done the next day showing a circumferential ulcer and no lumen could be identified. Biopsies were taken, which was negative for dysplasia or malignancy. After discussion with General Surgery, it was decided to proceed with Open Gastrostomy tube to allow enteral nutrition as well as access to dilate the esophagus in the retrograde fashion in the future. A repeat EGD after 4 weeks showed a healing ulcer and a blind pouch without an identifiable lumen. The ultrathin scope was advanced through the gastrostomy tract into the stomach and carefully advanced in a retrograde fashion through the lower esophageal sphincter throughout the esophagus. Narrowing was seen at the proximal end of the esophagus. The scope was advanced through this and with minimal resistance able to be advanced past the level of the stricture about 15 cm from the Incisors. Esophageal stent was deployed over the wire in an antegrade fashion with fluoroscopic guidance. This time, an area of concern was identified as a possible ZD proximal to the prior ulceration site which was later confirmed on an esophagram at the level of thoracic esophagus on the right side. Discussion: This case was challenging as the diagnosis of ZD was missed despite various testing. Patient had a long history of dysphagia and the impacted food led to ulceration and esophageal strictures. The diagnosis was established after a unique approach to the stricture. This case highlights that sometimes a careful examination is required as an approach to diagnosis of dysphagia in elderly.

Lumen reconstruction with magnetic compression anastomosis technique in a patient with complete esophageal stricture

Complete esophageal obstruction (CEO) is a rare condition of which treatment options are challenging. Surgery is the main treatment with high morbidity and mortality rates. Magnetic compression anastomosis (MCA) is a novel technique developed to restore lumen patency in gastrointestinal and biliary tracts. However, MCA experience is limited in respect of esophageal strictures. We present a 26-year-old patient having CEO. Magnets are inserted endoscopically to both sides of the obstructed area via oral and retrograde (through the gastrostomy tract) route. On day 8, magnets stuck together and were removed endoscopically through the oral route. Subsequently, sessions of balloon dilatations and triamcinolone injection were performed. The patient's complaint of aphagia resolved after the treatment process. In conclusion, MCA is an alternative technique that can be used to restore lumen patency in esophageal strictures and also avoids complications of surgical interventions.

Esophageal papillomatosis presenting with complete esophageal obstruction and high positron emission tomography avidity

A 70-year-old man weighing 100 pounds presented with dysphagia to solids and liquids. He had a history of esophageal human papillomavirus (HPV) infection, and a PEG tube was in place to provide nutrition and hydration. Biopsy at an outside hospital revealed esophageal papillomatosis. On EGD at our center, he was found to have a confluent mass of circumferential papillomatous lesions beginning 25 cm from the incisors (A, B). The lumen of the esophagus was almost completely obliterated. The upper endoscope could not be advanced to the stomach. Repeated biopsies, obtained to rule out malignancy, were interpreted as showing an atypical squamoproliferative lesion with parakeratosis consistent with papillomatosis. Although no clear malignancy was seen, this was thought to possibly be a manifestation of well-differentiated or verrucous squamous cell carcinoma (SCC). Positron emission tomography/CT revealed an exceptionally avid lesion occupying the esophagus (C, D). The patient was referred to surgery for consideration of esophagectomy but was thought to be a poor candidate for surgical intervention or chemoradiation therapy.

Per-oral endoscopic tunneling for restoration of the esophagus (POETRE) in the management of a complete esophageal obstruction.

Per-oral endoscopic tunneling for restoration of the esophagus (POETRE) in the management of a complete esophageal obstruction.

One Case of Esophageal Obstruction Caused by Enteral Nutrition

We report a case of complete esophageal obstruction caused by continuous enteral nutrition infusion via nasogastric tube. A 77 year old man received mechanical ventilation due to severe pneumonia and severe respiratory distress. He began using enteral nutrition emulsion (TPF) through a nasogastric tube on admission. 15 days later, due to the difficulty of re-inserting the nasogastric tube, endoscopy found a large number of coagulations in the esophagus, resulting in complete esophageal obstruction. We remove a small part of the foreign body with a net basket under gastroscope. After the operation, the nasogastric tube was placed in the middle of the esophagus again, which was perfused with 5% sodium bicarbonate and vinegar through the gastric tube. One week later, the esophagus was completely unobstructed by gastroscopy. A conclusion can be drawn that the precipitation and coagulation of TPF can lead to the whole esophageal obstruction. Endoscopic removal of foreign bodies, sodium bicarbonate and vinegar retention in the esophagus can treat the food obstruction caused by TPF.

Endoscopic recanalization using rendez-vous technique for complete upper esophageal obstruction: a case report

: Esophageal obstruction is a rare late adverse effect after head and neck cancer radiotherapy and chemotherapy treatment. The approach to complete esophageal obstruction is not well established in cases where malignant recurrence has been ruled out. We hereby present the case of a patient that presented with total dysphagia and multiple aspiration episodes. A minimally invasive endoscopic management was proposed for this complete esophageal obstruction. The endoscopic rendez-vous technique for esophageal recanalization requires an antegrade access through the mouth and a retrograde access through a feeding gastrostomy. Two interventional endoscopists locate and measure the length of the stenosis under fluoroscopic control. Once the axis of the two endoscopes is aligned, recanalization is achieved using a needle knife incision followed by balloon dilatation over a guide wire. Nasogastric (NG) tube insertion is performed at the end of the procedure to prevent premature recurrence of the stenosis. Subsequent dilatations were necessary after this procedure to obtain a satisfactory functional result. Post-operative speech therapy follow-up was also required. The endoscopic rendez-vous technique is hence a reliable and safe therapeutic option for short stenosis with transillumination. A multidisciplinary approach and long-term follow-up are mandatory in order to maximize the functional benefit for these complex patients.

Endoscopic recanalization of complete esophageal obstruction.

Complete esophageal obstruction (CEO) is a rare complication after radiochemotherapy that dramatically impairs quality of life. Within this study, we assessed the outcome of two different endoscopic techniques for lumen restoration in patients with CEO. 17 patients were included. Esophageal recanalization was performed in an antegrade approach (Group A) or through combined antegrade and retrograde recanalization and dilatation (CARD, Group B). Technical success, complications, and dysphagia development during follow-up (FU) were compared between the groups. In Group A (n = 6), esophageal recanalization was performed by a single endoscopist with a median duration of 47min. In two patients, antegrade recanalization led to formation of a false lumen (i.e., submucosal tunneling) followed by mediastinitis. In Group B, 21 CARD procedures were performed in 11 patients with a technical success rate of 100%. Procedure time was longer compared to Group A; however, no intra- or postprocedural complications were observed in Group B. In our experience and cohort, CARD was a successful procedure for recanalization of CEO, which exhibits a more favorable safety profile over antegrade recanalization. Further randomized studies to evaluate the treatment of CEO with CARD are needed.

S2013 A Rare Cause of Dysphagia – Epiphrenic Esophageal Diverticulum Complicated by Complete Esophageal Obstruction

INTRODUCTION: Epiphrenic esophageal diverticulum (EED) are a rare protrusion of the distal esophagus arising a few centimeters above the lower esophageal sphincter and is estimated to occur in 1:500,000 individuals per year. It results in motility dysfunction and typically presents as dysphagia and weight loss. Complications include upper GI bleed, esophageal carcinoma, and formation of atypical esophagorespiratory fistulas. CASE DESCRIPTION/METHODS: 66-year-old male with known history of Barrett’s esophagus and daily alcohol ingestion presented for 3 months of dysphagia with 22 kg weight loss. The initial esophagogastroduodenoscopy (EGD) demonstrated a large obstructive distal esophageal stricture for which Bougie French #60 dilation was performed at an outlying facility. Biopsy showed normal squamous mucosa. Two weeks later, dysphagia remained in which patient underwent CT chest that showed distended proximal thoracic esophagus and wall thickening with soft tissue mass involving the distal esophageal lumen consistent with obstruction; no extrinsic mass was noted (Figure 1). Laboratory workup including a complete blood count and comprehensive metabolic panel were within normal limits. Subsequent esophagram showed patulous and dilated esophagus with a large obstructive epiphrenic esophageal diverticulum (Figure 2). Esophageal ultrasound demonstrated food content within the esophageal false lumen (Figure 3). The patient subsequently had a PEG tube placed with plan to undergo traditional open transthoracic surgery with diverticulectomy and esophageal myotomy in the future. DISCUSSION: Most cases of epiphrenic esophageal diverticula are asymptomatic and do not warrant treatment though some may present with dysphagia, dyspepsia, and aspiration pneumonia. It is important to have a broad differential diagnosis including EED in patients with dysphagia. Delayed diagnosis and treatment could put patient at risk for life-threatening complications. Esophageal endoscopy is needed to rule out other dysphagia etiologies. Our case demonstrates complete esophageal obstruction leading to significant weight loss because of EED. In contrast to Zenker’s diverticulum, which occur in the proximal esophagus, EED are much rarer and occur in the distal esophagus. To contrast their rarity, EED occur at a ratio of 1:5 with that of Zenker’s. Traditionally, surgical resection is the treatment of choice. However, endoscopic techniques are being investigated.Figure 1.: CT chest shows dilated, obstructed, and irregular-shaped distal esophagus (red arrow) posterior to the pulmonary artery (PA). There is no extrinsic paraesophageal mass compression.Figure 2.: Esophagram shows epiphrenic esophageal diverticulum (red arrow) with complete distal esophageal obstruction indicates by the absence of contrast in the distal esophagus (black arrow); only an occasional trickle of contrast can be seen to transgress the distal esophagus into the fundus of the stomach. Note the proximity of the diverticulum to the cardiac silhouette.Figure 3.: Esophageal ultrasound showing food content within the esophageal false lumen at the 6 o’clock position.

Correction: Kissing scopes: treatment of complete esophageal obstruction using combined antegrade/retrograde approach.

Correction: Kissing scopes: treatment of complete esophageal obstruction using combined antegrade/retrograde approach.

Kissing scopes: treatment of complete esophageal obstruction using combined antegrade/retrograde approach.

Kissing scopes: treatment of complete esophageal obstruction using combined antegrade/retrograde approach.

Cuerpos extraños y cáusticos en el tracto digestivo superior

Foreign bodies (FB) ingestion is the second commonest cause of endoscopic emergency, causing sometimes severe complications. In patients suspected of FB or caustic substance ingestion is mandatory to verify both airway permeability and related complications. Anamnesis will give information regarding features of FB or caustic substances ingested. Radiologic test can provide FB location data as well as complication data. «Gold standard» for the diagnosis of caustic lesions is the gastroscopy. Endoscopic removal has to performed in 6 first hours in the following cases: complete esophageal obstruction, batteries placed in esophagus and stabbing/cutting FB. In remaining cases, depending on FB type and location, endoscopy can be carried out among 24-48hours. In cases of body-packers ingestion or perforation suspicion, endoscopy retrieve is contraindicated. Provoked vomiting, attempts to neutralize or to dilute the corrosive agent, are contraindicated in caustic agent ingestion. Therapeutic strategy varies according with endoscopic findings (Zargar's classification).