Georgios Mavrogenis, MD, from the Department of Hepatogastroenterology, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, in Brussels, Belgium describes this VideoGIE case “Recanalization of a complete postradiation esophageal obstruction with endoscopic submucosal dissection techniques.”
This video presents the management of a 30 cm post radiation esophageal obstruction by means of endoscopic submucosal dissection (ESD) techniques.
Strictures longer than 2.5 cm are difficult to treat and if endoscopic rendezvous techniques fail, surgery remains the only option. Endoscopic methods used for short strictures include puncture with an EUS needle, guidewire forceps, needle knife, and guidewires using simultaneous antegrade and retrograde endoscopy. Last year, an innovative technique of submucosal tunneling was introduced inspired by the POEM procedure. Hereby, we present a technique that permitted the restoration of the esophageal lumen by dissection of the fibrotic tissue using an ESD knife with spray coagulation. The endoscope was inserted through the preexisting gastrostomy tract.
Endoscopists can learn a new technique for the management of post radiation esophageal strictures that has the advantage of direct visualization. ESD may sound “exotic” and difficult, however, in this particular scenario, dissection of the post radiation fibrotic tissue was easy at least for the mid and distal esophagus. We had no problems of bleeding and the dissection was quite fast since the dissection plan was easy to identify. However, dissection of the proximal part that included the hypopharynx needed translumination (from the other side of the stricture) as well fluoroscopic guidance in order to find the right axis.
This work was done during my training in Saint Luc University Hospital. I would like to express my gratitude to the endoscopic team under the direction of Pr Deprez and Pr Piessevaux. In addition, I would like to thank Dr GS Raju for mentoring me in the production of endoscopic videos.
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