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RETROGRADE PLACEMENT OF AN ALVEOLUS ALIMAXX-E COVERED ESOPHAGEAL STENT VIA ENDOSCOPIC GASTROSTOMY FOR ESOPHAGEAL STRICTURE IN A CASE OF FAILED TRADITIONAL ESOPHAGEAL STENT PLACEMENT
P Tiwari, WP Pais, ML Bechtold, C Bartalos, MR Antillon
Division of Gastroenterology University of Missouri, Columbia, MO, USA
BACKGROUND: Various stents are available for use in esophageal strictures. Traditionally, in the upper gastrointestinal tract, stents are placed over the guidewire in the caudal direction by gaining access through the mouth. However, in certain situations, gaining guidewire access may not be possible though the mouth. We report a case of esophageal stent placement by gaining guidewire access via the percutaneous gastrostomy site due to failed placement through the mouth due to a significant stricture.
CASE REPORT: 64 year-old female with esophageal stricture due to intestinal bypass surgery for weight loss presented to our tertiary-care gastroenterology clinic with recurrent bouts of aspiration pneumonia. Her nutritional needs were met using a gastrostomy feeding tube. She experienced multiple attempted esophageal dilatations which were unsuccessful. At endoscopy, guidewire access across the esophageal stricture using the endoscope via the mouth could not be performed. We inserted an ultra-thin endoscope via the gastrostomy site and still could not pass the guidewire across the stricture. Subsequently, we passed the ultra-thin scope through the gastrostomy site and the regular endoscope through the mouth. We aligned them under fluoroscopy. We passed a Boston Scientific Microvasive 0.035/450 Jagwire under fluoroscopy through the ultra-thin endoscope passed via gastrostomy site into the esophagus and retrieved it in the mouth. Then, the regular endoscope was passed over the guidewire from the mouth to the esophagus. The esophagus was dilated up to 12 mm in a progressive fashion. An ALVEOLUS ALIMAXX-E covered esophageal stent, 22 × 100 mm, was successfully placed across the stricture. Endoscopic and fluoroscopic verification was performed to confirm successful placement of stent. A new PEG tube was successfully placed. Immediately following the procedure patient was able to eat. Upon removal of the stent 6 weeks later, the esophagus was patent and eating was possible. No complications were observed.
CONCLUSIONS: In cases where esophageal stricture prevents the placement of stent in traditional fashion, the guidewire access and successful stenting can be carried out via a percutaneous gastrostomy.