Endoscopy 2018; 50(04): S72-S73
DOI: 10.1055/s-0038-1637242
ESGE Days 2018 oral presentations
21.04.2018 – Video session 1
Georg Thieme Verlag KG Stuttgart · New York

ENDOSCOPIC MANAGEMENT OF EOSINOPHILIC ESOPHAGITIS PRESENTING AS A DOUBLE LUMEN OESOPHAGUS

J Santiago-Garcia
1   Nottingham Digestive Diseases Centre, NIHR Nottingham Biomedical Research Centre, University of Nottingham and Nottingham University Hospitals NHS Trust, Nottingham, United Kingdom
,
J Duffy
1   Nottingham Digestive Diseases Centre, NIHR Nottingham Biomedical Research Centre, University of Nottingham and Nottingham University Hospitals NHS Trust, Nottingham, United Kingdom
,
J Ortiz-Fernández Sordo
1   Nottingham Digestive Diseases Centre, NIHR Nottingham Biomedical Research Centre, University of Nottingham and Nottingham University Hospitals NHS Trust, Nottingham, United Kingdom
,
S Budihal
1   Nottingham Digestive Diseases Centre, NIHR Nottingham Biomedical Research Centre, University of Nottingham and Nottingham University Hospitals NHS Trust, Nottingham, United Kingdom
,
A Parra-Blanco
1   Nottingham Digestive Diseases Centre, NIHR Nottingham Biomedical Research Centre, University of Nottingham and Nottingham University Hospitals NHS Trust, Nottingham, United Kingdom
,
K Ragunath
1   Nottingham Digestive Diseases Centre, NIHR Nottingham Biomedical Research Centre, University of Nottingham and Nottingham University Hospitals NHS Trust, Nottingham, United Kingdom
› Author Affiliations
Further Information

Publication History

Publication Date:
27 March 2018 (online)

Also available ateRef
 
 

    Background and aims:

    Eosinophilic esophagitis (EoE) is a chronic immune condition presenting with symptoms of dysphagia, food impaction, chest pain and heartburn. The most common complication is narrowed esophagus and stricture. Treatment includes diet modifications and medical therapy such as proton pump inhibitors and topical glucocorticoids. Endoscopic treatment with dilatation is mostly reserved for patients developing strictures during the course of the disease. We are reporting a video demonstration of a rare presentation of EoE and how it was successfully managed endoscopically.

    Methods:

    19 year old male with no medical co-morbidities reporting a 5 years history of dysphagia and one episode of food impaction. Baseline endoscopy showed two esophageal lumens 32 – 37 cm from the incisors separated by a well-established septum and a narrowed gastro-esophageal junction (GEJ), which was successfully dilated up to 18 mm. Distal and mid esophageal biopsies confirmed EoE. Plan for endoscopic treatment. Second endoscopy showed again two mild strictures at 25 cm and GOJ, both sequentially dilated up to 18 mm. The septum was then successfully divided with the SB Knife™, a monopolar ESD knife (BVM Medical Ltd., UK). ERBE™ settings used were pulsed cut fast 20 watts and soft coagulation 40 watts. A follow-up gastroscopy 4 weeks later showed evidence of the already known two mild strictures, again dilated, and a completely resolved septum. Patient is asymptomatic now and has been started on fluticasone oral slurry. This video demonstrates the esophageal septum being divided with the SB knife.

    Conclusions:

    Double lumen esophagus is an extremely rare endoscopic finding, only about 15 cases have been previously described. All reported cases were related to previous esophagogastric surgery, persistent gastro-esophageal reflux disease or previous interventions like NJ tube placement. To our knowledge this is the first case reported as a complication of EoE and we have shown a successful endoscopic treatment with septectomy.