Milan S. Bassan, MBBS, FRACP, from the Department of Gastroenterology and Hepatology, Liverpool Hospital, in Liverpool and University of New South Wales, in Sydney, Australia presents this VideoGIE case, “Incision therapy for an unusual esophageal stricture.”

This is a case of a refractory benign esophageal stricture due to typhoid. As bougie and balloon dilation had been unsuccessful in dilating, the stricture needle knife incision therapy was used.

This video demonstrates the technique of needle knife incision therapy. It highlights the importance of using the correct anatomical landmarks to determine the safest depth of maximal incision as there was extensive structuring distal to the main stricture that meant the lumen was narrowed distal to the stricture as well.

In the correct clinical context, typhoid should be considered as a cause for benign esophageal stricture formation. Needle knife incision therapy is a useful technique to manage refractory benign esophageal strictures but extremely close attention must be paid to the anatomical landmarks to determine how deep the incisions can safely be made.

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