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Endoscopy 2020; 52(08): E271-E272
DOI: 10.1055/a-1089-7551
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Open peroral endoscopic myotomy for refractory benign esophageal stricture

Chuncheng Wu‡   *
1   Department of Gastroenterology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
,
Shuanghong Luo‡   *
2   Department of Pediatrics, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China
,
Linjie Guo
1   Department of Gastroenterology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
,
Bing Hu
1   Department of Gastroenterology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
› Author AffiliationsThe authors thank Sichuan Province Science and Technology Department (China) (2018SZ0134) for their support.
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A 36-year-old woman suffered thoracic pain and dysphagia following a barbecue 6 months earlier. Gastroscopy showed an ulcer in the lower esophagus. The thoracic pain disappeared after taking proton pump inhibitors (PPIs) for a week, but dysphagia continued. Repeat gastroscopy showed a thickened and rigid lower esophageal wall and esophageal stricture ([Fig. 1 a]). The stricture was about 4.0 cm from the cardia. Endoscopic biopsy diagnosed inflammation. Esophagography showed severe stricture in the lower esophagus ([Fig. 2 a]). Thoracic computed tomography showed a thickened lower esophageal wall, and endoscopic ultrasonography showed thickening of the muscularis propria in the lower esophagus ([Fig. 3]), without manifestation of tumors. The patient continued to take PPIs and underwent three sessions of endoscopic dilation, without success; she lost 8.0 kg in weight.

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Fig. 1 Gastroscopy. a Pre-procedure, showing a thickened and rigid lower esophageal wall and a stricture. b At follow-up, showing that the incision had healed well, with only mild stricture remaining.
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Fig. 2 Esophagography. a Pre-procedure, showing severe stricture of the lower esophagus. b At follow-up, showing significant improvement, with only mild stricture.
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Fig. 3 Endoscopic ultrasonography showed a thickened muscularis propria in the lower esophagus.

We performed open peroral endoscopic myotomy (O-POEM) ([Video 1]). The mucosal and circular muscle layers of the stricture were incised completely without submucosal tunnel creation ([Fig. 4]), and with the upper and lower edge incisions extending about 2.0 cm beyond the stricture.

Video 1 The lower esophagus was rigid and strictured, and the mucosal and circular muscle layers of the stricture were incised completely without submucosal tunnel creation.


Quality:
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Fig. 4 The mucosal and circular muscle layers of the stricture were incised completely without submucosal tunnel creation.

The patient recovered uneventfully after endoscopic treatment and gradually returned to a normal diet. Her body weight had increased by 4.0 kg at 6 months after treatment. Follow-up esophagography showed that the stricture had significantly improved post-procedure ([Fig. 2 b]). Follow-up gastroscopy showed that the original esophageal incision had healed well and the lumen was only mildly strictured ([Fig. 1 b]), with smooth passage of the endoscope.

Endoscopic balloon dilation [1] or stenting [2] is an effective treatment for benign esophageal stricture. Radial incision and cutting [3] can also be performed. Due to the poor effect of balloon dilation, the rigid wall, and the presence of stricture, we performed O-POEM for this patient. O-POEM is a safe and effective treatment for achalasia [4], as well as an effective therapy for benign esophageal stricture.

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* These authors contributed equally to this work.




Publication History

Article published online:
29 January 2020

© Georg Thieme Verlag KG
Stuttgart · New York

 

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