Clin Endosc.  2016 Nov;49(6):560-563. 10.5946/ce.2016.048.

An Intractable Caustic Esophageal Stricture Successfully Managed with Sequential Treatment Comprising Incision with an Insulated-Tip Knife, Balloon Dilation, and an Oral Steroid

• Lee WK
• Kim BS
• Yang MA
• Yun SH
• Lee YJ
• Kim JW
• Cho JW

• KMID: 2383453
• DOI: http://doi.org/10.5946/ce.2016.048

Abstract

Bougie or balloon dilation is a good short-term treatment for caustic esophageal strictures, although recurrence after dilation occurs in approximately 30% of these cases. Therefore, long-term treatment options are required in some cases, and endoscopic incisional therapy has been used for patients with an anastomotic stricture in the gastrointestinal tract. A 58-year-old woman presented with severe swallowing difficulty because of a caustic esophageal stricture, which was caused by accidental exposure to anhydrous acetic acid at infancy. She had undergone several previous bougie and balloon dilations but the stricture did not improve. We performed sequential treatment comprising incision with an insulated-tip knife, balloon dilation, and an oral steroid, which resulted in the patient's symptoms markedly improving. Thus, we report this case of an intractable caustic esophageal stricture, which was successfully treated using combined endoscopic sequential treatment.

Keyword

Esophageal stenosis; Caustics; Deglutition disorders; Dilatation

MeSH Terms

Acetic Acid
Caustics
Constriction, Pathologic
Deglutition
Deglutition Disorders
Dilatation
Esophageal Stenosis*
Female
Gastrointestinal Tract
Humans
Middle Aged
Recurrence
Acetic Acid
Caustics

Figure

• 

  Fig. 1. The esophageal stricture was located 18 cm from the incisor.

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  Fig. 2. Endoscopy reveals a severe stricture in the cervical esophagus.

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  Fig. 3. Fluoroscopic imaging of an unsuccessful attempt to use balloon dilation to treat the narrowed segment.

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  Fig. 4. Incisional therapy using an insulated-tip electrosurgical knife.

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  Fig. 5. Endoscopy immediately after the incisional therapy reveals marked improvement at the stricture.

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