P3296 - A Door to Relief: Severe Case of Malignant Esophageal Stricture Treated With a Biliary Stent

Arthur Ter-Zakarian, BS¹, Neil Patel, DO¹, William Ghaul, DO¹, Travis Magdaleno, DO¹, Shashin Shah, MD^2
1Lehigh Valley Health Network, Allentown, PA; ²Eastern Pennsylvania Gastrointestinal and Liver Specialists, Allentown, PA

Introduction: Esophageal carcinoma is a devastating disease with less than 10% of patients surviving at least 5 years from diagnosis. Advanced stages of disease are typically incurable; however, esophageal stenting is an option to palliate dysphagia which burdens more than 70% of these patients. Here, we highlight a severe case of malignant esophageal stricturing effectively treated with a biliary self-expandable metal stent.

Case Description/Methods: A 77-year-old male with a past medical history of metastatic esophageal adenocarcinoma presented for failure to thrive and progressive dysphagia to both solids and liquids for 1 week. CT chest imaging revealed persistent esophageal thickening and mild dilation. Barium esophagram demonstrated 3 cm of severe narrowing at the gastroesophageal junction with minimal contrast transit into the stomach. EGD revealed a severe distal esophageal stricture that was traversed with a 0.025-inch guidewire. Using fluoroscopy and advancement of 912 extraction balloon over the guidewire, the stricture length was able to be approximated at 25 to 30 mm. Following balloon catheter removal, a fully covered 10 mm by 80 mm metal biliary stent was deployed across the stricture and secured with suture to the esophageal wall. Fluoroscopic film confirmed appropriate stent placement. Patient tolerated liquid diet following procedure and was recommended to advance diet as tolerable until outpatient GI follow-up.

Discussion: Stents have remained a palliative option for malignant esophageal strictures since at least 1992. However, traditional endoscopic stenting may not be effective in patients with severe disease. Off-label usage of biliary stents for malignant esophageal stricture has rarely been documented with only a few anecdotal cases in the literature. Our case hopes to highlight the extra-biliary usage of these stents to relieve malignant esophageal stricturing and restore quality of life. With further studies, the smaller diameter biliary stents may demonstrate a purpose in recanalizing severe narrowing of the esophageal lumen and offload the symptomatic burden for these patients.


Disclosures:


Arthur Ter-Zakarian, BS¹, Neil Patel, DO¹, William Ghaul, DO¹, Travis Magdaleno, DO¹, Shashin Shah, MD². P3296 - A Door to Relief: Severe Case of Malignant Esophageal Stricture Treated With a Biliary Stent, ACG 2023 Annual Scientific Meeting Abstracts. Vancouver, BC, Canada: American College of Gastroenterology.