Korean J Gastroenterol.  2023 Sep;82(3):140-144. 10.4166/kjg.2023.080.

Successful Simultaneous Treatment of Benign Stricture and Colonic Neoplasm Arising from Colonic Interposition after Esophagectomy: A Case Report

• Kim SH
• Kim JW
• Park SY
• Kim HS
• Lim CJ
• Lee GH
• Lim JW
• Seo YE
• Park SY
• Lee YH
• Jung YW
• Kang WR
• You HS
• Kim DH

• KMID: 2546516
• DOI: http://doi.org/10.4166/kjg.2023.080

Abstract

Colonic interposition is the main procedure used in esophageal reconstruction. We report a rare case of simultaneous treatment of an anastomotic site stricture and a neoplasm in the interpositioned colon. A 69-year-old female visited our outpatient clinic with symptoms of progressive dysphagia for 1 year. At the age of 30 years, the patient underwent esophagectomy with retrosternal colonic interposition because of severe esophageal burns after chemical ingestion. Upper gastrointestinal endoscopy revealed stricture at the anastomosis site and a 10-mm flat elevated high-grade dysplasia in the interpositioned colon. First, through-the-scope balloon dilatation was performed for strictures. However, stenosis was observed during the second upper gastrointestinal endoscopy session. Therefore, a second session of through-the-scope balloon dilatation was performed, and simultaneously, endoscopic submucosal dissection was also successfully performed. After 2 months of follow-up, stenosis persisted; consequently, balloon dilatation was performed. No recurrence of neoplasm was confirmed endoscopically. Through-the-scope balloon dilatation of the stricture site and simultaneous endoscopic submucosal dissection of the neoplasm in the interpositioned colon were successfully performed.

Keyword

Colonic neoplasms; Dilatation; Endoscopy; Esophageal stenosis; Stricture

Figure

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  Fig. 1 The first through-the-scope (TTS) balloon dilatation to treat the stenosis. (A) An approximately 18–23 cm site from the upper incisor, which is the proximal anastomotic site, demonstrating luminal narrowing with near total obstruction. (B–D) Treatment with the first TTS balloon dilatation.

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  Fig. 2 Feature of the detected nodular lesion, treated by endoscopic submucosal dissection (ESD), and pathological examination results. (A, B) An approximately 10-mm nodular lesion was observed at 33 cm from the upper incisor position. (C, D) Performance of ESD. (E, F) Resected tissue. (G, H) Histologic examination of the resected lesion revealed a high-grade dysplasia with R0 resection (hematoxylin and eosin staining; magnification, ×20 and ×100, respectively).

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  Fig. 3 Through-the-scope (TTS) balloon dilatation was repeated due to re-stenosis, and endoscopic submucosal dissection (ESD) of the site was checked. (A) Follow-up endoscopy that confirmed recurrence of the stenosis. (B) A third TTS balloon dilatation was performed. (C, D) ESD scar lesion was checked. No evidence of recurrence was observed endoscopically.

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