Clinical Endoscopy

Case Report

Removal of Esophageal Variceal Bands to Salvage Complete Esophageal Obstruction: Ala’ A Abdel Jalil, Ghassan Hammoud, Jamal A Ibdah, Sami Samiullah; Clin Endosc 2018;51(5):491-494. Published online August 21, 2018; DOI: https://doi.org/10.5946/ce.2018.011

Esophageal varices develop in almost half of the patients with cirrhosis, and variceal hemorrhage constitutes an ominous sign with an increased risk of mortality. Variceal banding is considered an effective and mostly safe measure for primary and secondary prophylaxis. Although adverse events related to banding including dysphagia, stricture formation, bleeding, and ligation-induced ulcers have been described, complete esophageal obstruction is rare, with only 10 reported cases in the literature. Among those cases, 6 were managed conservatively; 1 patient had esophageal intraluminal dissection from an attempt to remove the bands using biopsy forceps but ultimately recovered with conservative management. Three patients developed strictures following removal of the bands, requiring repeated sessions of dilation therapy. We report on a patient who developed absolute dysphagia and complete esophageal obstruction after variceal banding. We successfully used the endoloop cutter hook to release the bands intact and restore luminal integrity.

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Esophageal necrosis and obstruction after esophageal variceal banding
Simran Gupta, Emily Zhou, Jason Ferreira, Arkadiy Finn
Journal of Brown Hospital Medicine.2022;[Epub] CrossRef

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원저 : 식도 위장관 ; 실리콘 피막형 인공식도관을 이용한 악성식도협착 및 식도기관지누공의 치료 ( Original Articles : Esophagus , Stomach & Intestine ; Silicone - Covered Self - Expandable Metal Stents for the Palliation of Malignant Esophageal Obstruction and Esophagorespiratory Fistulas ): Korean J Gastrointest Endosc 1998;18(1):1-10. Published online November 30, 1997

Abstract PDF: Background
Esophageal cancer can induce progressive dysphagia and occasionally develop esophagorespiratory fistulas. Surgically incurable disease is present in over 60% of patients at the time of presentation and in such a means, relief of dysphagia is one of the important treatment modes in the majority of these patients. Implantation of stents is widely used for improvement of dysphagia and sealing of esophagorespiratary fistulas. Methods: Silicone-covered self-expandable metal stents were used in 19 consecutive patients with malignant esophageal obstruction(n=14) or esophageal obstruction with esophagorespiratory fistulas (n=5). Results: The stents were successfully inserted in all patients. Dysphagia improved in 18 of 19 patients(95%). All fistulas were sealed and symptoms due to bronchial aspiration disappeared. Complications occurred during follow-up including chest pain(11 patients), aspiration pneumonia(4 patients), reflux esophagitis(2 patients), stent migration(2 patients), tumor overgrowth(2 patients) and hemorrhage(1 patient). Three of the 4 patients with aspirtion pneumonias and a patient with hemorrhage suffered from dysfunction of upper esophageal sphincter after implantation of stents in upper esophageal carcinoma. But, Tumor ingrowth and perforation did not occur. Two patients died of massive hemorrhage and respiratory failure caused by aspiration pneumonia. Conclusion: These results suggest that implantation of silicone-covered self-expandable metal stents is a rapid and effective procedure for the palliative treatment of malignant esophageal obstruction and esophagorespiratory fistulas. (Korean J Gastrointest Endosc 18: 1-10, 1998)

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