Post written by Bing Chen, MD, from the Department of Gastroenterology, Hepatology and Nutrition, Geisinger Medical Center, Danville, Pennsylvania, USA.

A 44-year-old man who had eosinophilic esophagitis (EoE) for >20 years presented with chronic dysphagia to solid food. During upper endoscopy, a complex stricture was found 22 to 28 cm from the incisors.

To gather more information about the stricture, we proceeded with the functional luminal imaging probe (FLIP [EndoFlip; Medtronic, Minneapolis, Minn, USA]). The diameter was measured as around 12 mm. The distensibility index was 0.77 mm²/mm Hg, indicating a low value that may suggest a fibrostenotic stricture. The stricture length was estimated as 3 cm using the FLIP.

First, dilation was performed with a dilating cap with no resistance at 12 mm. Mild resistance was encountered with a 14-mm dilating cap, and there was significant resistance at 16 mm (Fig. 1).

After dilation, there were 2 jagged and deep mucosal tears without evidence of perforation. A repeat dilation was performed 2 weeks later with the dilating cap and then an 18-mm wire-guided Savary dilator, with a similar jagged mucosal tear and complete resolution of the luminal narrowing.

Currently, no available endoscopic technique can objectively characterize lengths of an esophageal stricture. Our case highlights that the FLIP can provide measurements of length and diameter of an EoE-associated esophageal stricture. Our case also adds to the literature demonstrating the safety and effectiveness of the dilating cap in EoE strictures.

In addition, our video highlights the relatively newer optical-haptic dilation (OHD), which represents another useful technique to manage esophageal strictures, including EoE strictures.

The FLIP has the potential to aid in determining appropriate dilation strategy in terms of the starting diameter of dilators to be used. OHD with a dilating cap can offer direct visualization and real-time feedback of resistance to dilator passage during the dilation process.

The use of OHD with a tapered dilating cap provides an effective means of accomplishing dilation in EoE. A distinct advantage is the ability to more accurately define luminal diameter, allowing precise selection of dilator diameters.

Optic-haptic dilation of the eosinophilic esophagitis stricture using the dilating cap.

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