A 54-year-old man underwent a proximal gastrectomy with partial esophagectomy to treat
a carcinoma of the cardia 5 years ago. A persistent postoperative fistula of the esophago-gastric
anastomosis occurred, which required a second surgery 4 years ago during which a colon
interposition was performed. After surgery, stricture of the esophagus-colonic anastomosis
developed 2 cm distal from the upper esophageal sphincter, causing grade 3 dysphagia
for which the patient underwent multiple dilations with Savary–Gilliard bougies. As
the stenosis was deemed refractory to serial dilations, a biodegradable esophageal
stent (BD stent 019-10A-23/18/23-060; SX-ELLA, Hradec Kralove, Czech Republic) was
placed 1 year ago ([Fig. 1]).
Fig. 1 Radiologic view showing a biodegradable esophageal stent placed to treat a refractory
esophagus-colonic stricture.
Although transient improvement was noticed, the patient experienced recurrent dysphagia
1 month later and required further dilations 4 months later. Hence, a 4 cm diabolo-shaped,
covered, biliary, self-expandable metallic stent (SEMS; Hanarostent BCF-10-040-180;
M.I. Tech Co., Seoul, Korea), 10 mm in diameter and with flares 5 mm long and 24 mm
in diameter, was placed under direct and fluoroscopic view ([Fig. 2], [Fig. 3], [Fig. 4]) using a therapeutic channel endoscope (GIF 2T130; Olympus, Tokyo, Japan). The stent
was well tolerated and the patient noticed an immediate substantial improvement from
grade 3 to grade 1 dysphagia.
Fig. 2 Radiologic view of a diabolo-shaped, covered, biliary, self-expandable metallic stent
placed at the stricture site.
Fig. 3 Radiologic view following injection of contrast through the diabolo-shaped stent,
showing adequate expansion and permeability.
Fig. 4 Contrast was also seen passing through to the interposed colon.
The stent was exchanged three more times at 8-week intervals using the proximal lasso
for stent removal; increasing improvement in the diameter of the stenosis was observed.
The final two procedures were performed under direct view only ([Fig. 5], [Fig. 6], [Video 1], [Video 2]). The patient remained asymptomatic after removal of the final stent.
Fig. 5 Endoscopic view showing easy passage of the endoscope inside the stent.
Fig. 6 Endoscopic view showing the dilated stricture after removal of the stent.
Endoscopic video showing the removal of a diabolo-shaped self-expandable metallic
stent (SEMS) placed to treat a refractory esophagus-colonic stricture near the upper
esophageal sphincter. The SEMS was removed by pulling the lasso with a snare.
A new self-expandable metallic stent was placed in the stenotic stricture under exclusive
endoscopic view.
Diabolo-shaped stents have important technical advantages for stenoses near the upper
esophageal sphincter, as they have shorter and larger flares that limit patient intolerance
and prevent migration, respectively. Furthermore, the diameter of the delivery device
permits its placement under direct endoscopic view using a therapeutic endoscope,
resulting in accurate positioning [1]
[2]
[3]
[4].
Endoscopy_UCTN_Code_TTT_1AO_2AZ