Clin Endosc.  2021 Jan;54(1):122-126. 10.5946/ce.2019.206.

Esophageal Stricture Caused by the Ingestion of Undissolved Picosulfate Powder

• Kim D
• Cho B
• Choi JW
• Kim KB
• Park SM

• KMID: 2512317
• DOI: http://doi.org/10.5946/ce.2019.206

Abstract

Picosulfate solution is widely used as a small volume bowel cleansing agent and is considered to be effective and relatively safe. A case of a 75-year-old woman ingested picosulfate powder and drank a small volume of water, subsequently experienced severe burning pain in the chest. Endoscopy was performed and showed a submucosal hemorrhage and exudative ulcers at the mid to lower esophagus. At 2 weeks, her symptoms improved with conservative treatment. However, liquid food dysphagia developed 11 weeks after ingestion. A follow-up endoscopy revealed multiple esophageal strictures, which were treated with a fully covered metal stent and esophageal balloon dilation. Consequently, the esophageal strictures improved after one year. As this case demonstrates, detailed information about picosulfate powder ingestion after dissolving it in more than 200 mL of water should be presented to patients to avoid esophageal injury.

Keyword

Caustic esophageal injury; Esophageal stricture; Patient education; Picosulfate

Figure

• 

  Fig. 1. Endoscopic findings at 1 day after ingestion of picosulfate powder. Endoscopy reveals submucosal hemorrhage, ulcerative lesions, and spotty necrosis along the whole esophagus. Caustic injury is more severe in the mid esophagus (B, C) than the upper (A) or lower (D) parts.

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  Fig. 2. Image findings at 1 week after ingestion. Endoscopy reveals diffusely scattered yellowish exudates (A), mucosal sloughing (B), and multiple ulcers (C, arrows) throughout the esophagus and linear erythematous lesions in the stomach (D). An endoscopic biopsy (E) shows fungal pseudohyphae (white arrows) and a few yeasts (black arrows) in the esophageal mucosa on PAS stain (original magnification, X400). A neck CT scan (F) reveals esophageal edema (arrow) and increased wall enhancement (arrowhead).

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  Fig. 3. Endoscopic findings at 2 weeks and 11 weeks after ingestion. Luminal narrowing and esophageal ulcers covered with exudates at 2 weeks (A). The narrowest part of the esophageal stricture (B) caused by healed ulcer scars at 11 weeks after ingestion. Esophageal stricture was treated with fully covered metal stenting for 3 months (C, D).

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  Fig. 4. Endoscopic findings at 8 months and 12 months after ingestion. Restenosis at the mid esophagus after stenting (A) is treated with esophageal balloon dilation (B). Luminal stenosis relief by mucosal tearing (C, arrows) and remaining ulcer scars (D, arrow).

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