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CC BY 4.0 · Endoscopy 2023; 55(S 01): E662-E663
DOI: 10.1055/a-2067-4681
E-Videos

Cleft palate: a rare complication following esophageal stent implantation

Wei Liu
1   Department of Gastroenterology and Hepatology, West China Hospital, Sichuan University, Chengdu, China
,
Ou Chen
2   Department of Gastroenterology, Ya’an People’s Hospital, Ya’an, China
,
Lifan Zhang
1   Department of Gastroenterology and Hepatology, West China Hospital, Sichuan University, Chengdu, China
,
Bing Hu 
1   Department of Gastroenterology and Hepatology, West China Hospital, Sichuan University, Chengdu, China
› Author AffiliationsSupported by: National Natural Science Foundation of China http://dx.doi.org/10.13039/501100001809 82170675
Supported by: Chengdu Science and Technology Project 2022-YF05-01722-SN
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A 50-year-old woman was referred to our hospital because of increasing dysphagia. She had been diagnosed with systemic lupus erythematosus 2 years previously and started on treatment with tacrolimus and corticosteroids. Multiple diverticula of the esophagus were confirmed and the largest diverticulum was located next to the cardia. Esophagogram showed delayed passage of contrast into the stomach, and gastroscopy revealed a dilated esophagus with retained liquid and increased resistance at the cardia ([Fig. 1 a–c]). The patient refused to undergo endoscopic or surgical myotomy as she was concerned about the treatment risks. Therefore, esophageal stent implantation was believed to be an option for this case.

Zoom Image
Fig. 1 Cleft palate: a rare complication following esophageal stent implantation. a Esophagogram showed multiple diverticula of the esophagus and delayed passage of contrast into the stomach (black arrow). b, c Gastroscopy revealed multiple diverticula in the dilated esophagus with retained liquid and increased resistance at the cardia (black arrow); the largest diverticulum was located next to the cardia (red arrow). d A fully covered retrievable self-expandable metal stent (SEMS) was positioned and deployed, and a thread was fixed to the patientʼs nose to prevent stent migration (black arrow). e Stent retrieval was performed 2 months later and endoscopy revealed decreased resistance at the cardia (black arrow). f A cleft palate was caused by the thread that fixed the SEMS (black arrow).

During treatment, the most appropriate dimension of the self-expandable metal stent (SEMS) was determined by judging the location of the multiple diverticula based on endoscopic assessment; a fully covered retrievable SEMS (Micro-Tech, Nanjing, China) with a size of 20 mm × 140 mm was selected. The SEMS delivery system was advanced across the cardia over the guidewire, and the SEMS was then positioned and deployed adequately under endoscopic view; a thread was fixed to the patient’s nose to prevent stent migration ([Fig. 1 d]).

Follow-up endoscopy and stent retrieval were performed 2 months later. The dysphagia had improved significantly and endoscopy revealed decreased resistance at the cardia ([Fig. 1 e]). However, the thread that fixed the SEMS had caused a cleft palate ([Fig. 1 f], [Video 1]). After consulting an oral surgeon, repair surgery was not recommended as the patient had no obvious symptoms associated with the cleft palate.

Video 1 Cleft palate: a rare complication following esophageal stent implantation.


Quality:

Cleft palate caused by esophageal stent implantation has never been reported before. Although SEMS was effective for this patient, fixing the thread to the nose is very risky and dangerous, and alternative tools (e. g. hemoclips, suturing, over-the-scope clip) should be used to prevent migration and the occurrence of such complications [1] [2] [3] [4].

Endoscopy_UCTN_Code_CPL_1AH_2AD

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Publication History

Article published online:
21 April 2023

© 2023. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/)

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