Complex Esophageal Stricture Managed with Balloon Dilation and Fully‐Covered Metal Stent

Abstract

A 3-year-old girl with a history of metastatic paraspinal neuroblastoma status post resection and bone marrow transplantation, complicated by chemotherapy-related mucositis (cyclophosphamide and topotecan), presented with feeding intolerance and an esophageal stricture on an esophagram. An esophagogastroduodenoscopy showed a distal esophageal stricture ~3 cm above the lower esophageal sphincter, measured to be 5.5 mm in diameter and 2 cm long using endoluminal functional lumen imaging probe (End-oFLIP) (Fig. 1A and B). The stricture was dilated to 9 mm using a controlled radial expansion balloon. Due to the degree of scarring, mucosal friability, and bleeding after dilation, a 10-60 mm fully-covered self-expandable metal biliary stent was placed in the distal esophagus over a guidewire under both fluoroscopic and endoscopic guidance, serving as a luminal tamponade and, to a lesser degree, dilation force (Fig. 1C). An over-the-scope clip was placed at the top of the stent to secure it against the mucosa and prevent migration (Fig. 1D). Reports have described the use of biliary stents in the esophagus in children (1-3), which have a smaller diameter compared to traditional esophageal stents. The patient did well afterwards with improved oral intake. The stent remained in place for ~1 month before removal. Various endoscopic tools can be incorporated in the management of complex strictures. EndoFLIP can be used to guide dilation balloon size selection (4). Esophageal stenting can be considered in cases of difficult stricturesThe authors report no conflicts of interest.