Endoscopic removal of obstructing sutures

Jennifer KolbJennifer M. Kolb from the Icahn School of Medicine at Mount Sinai in New York shares this video case “Endoscopic removal of obstructing sutures using argon plasma coagulation” from the VideoGIE section.

We present two unusual cases of persistent dysphagia, months after Ivor Lewis esophagectomy for esophageal adenocarcinoma, caused by retained sutures and staples blocking the passageway of food and fluid through the esophagus. We demonstrate the use of argon plasma coagulation (APC) at 30-W forced coagulation at 1 L/min to completely remove the PDS sutures from the esophagus with minimal damage to the underlying mucosa. We use the smaller diameter 4.5 fr catheter for precise APC application, using small bursts to melt the suture and staples. This method is safe and effective and can be performed by any endoscopist trained to use APC. After removing the obstructing sutures, we proceeded with balloon dilation of the narrowed anastomosis. Suture removal with APC treatment and subsequent stricture dilation led to significant improvement in symptoms and quality of life.

This video identifies a unique approach to treating dysphagia caused by retained suture in the post esophagectomy patient. Both of these patients suffered for many months after surgery and were unable to eat or drink requiring tube feeds. If dysphagia persists after surgery, perform early endoscopy to evaluate the cause. Here we provide the first contribution to the literature on this topic and describe a safe and effective method to remove suture endoscopically.

These cases teach that removal of retained suture after esophagectomy can be safe, easy, and effective using Argon Plasma Coagulation. Endoscopists are encouraged to follow this approach when encountering similar clinical scenarios.

Find more VideoGIE cases online.

The information presented in Endoscopedia reflects the opinions of the authors and does not represent the position of the American Society for Gastrointestinal Endoscopy (ASGE). ASGE expressly disclaims any warranties or guarantees, expressed or implied, and is not liable for damages of any kind in connection with the material, information, or procedures set forth.

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