Ahmed Sharata, MD1, Christy Dunst, MD1, Ezra Teitelbaum, MD2, Marc Ward, MD2, Kevin Reavis, MD1, Steven DeMeester, MD1, Lee Swanstrom, MD1. 1Oregon Clinic/GMIS, 2Portland Providence Cancer Center
Introduction: A gastro-esophageal anastomosis stricture post esophagectomy are a common complication and often refractory to treatment. It is frequently presented with dysphagia, regurgitation, aspiration, weight loss, and halitosis, which all adversely affect the patient’s quality of life. Traditionally, the stricture is managed endoscopically with various techniques such as dilation, steroid injection, and strictureplasty. We are presenting an endoscopic technique to manage gastroesophageal anastomosis stricture associated with proximal esophageal pouch.
Methods: A referred post-esophagectomy patient presented with dysphagia and regurgitation. An anastomotic stricture was confirmed after work up and the UGI study showed esophageal pouch at the proximal side of the anastomosis. We used the endoscope with needle knife to perform rectangular resection of the common wall of the anastomosis at the pouch side as an approach to reconstruct the anastomosis and eradicate the pouch as shown in the video. A secure mucosal closure was performed using an over-the- scope suturing device.
Results: Patient was extubated. A swallow did not reveal a leak. The pouch was eradicated as shown. Diet was resumed and the patient was discharged. The patient’s symptoms completely eradicated after the endoscopic revision.
Discussion: The developments of new endoscopic technologies have facilitated the transformation of the endoscope into a truly therapeutic surgical tool. The endoscope should be increasingly considered an interventional option to apply the surgical principles especially when traditional surgical approach is morbid.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 79851
Program Number: V074
Presentation Session: Endoscopy Video Session
Presentation Type: Video