Novel technique for management of esophageal strictures: double “J” stents and the use of urologic dilators

Abstract

Current management of esophageal strictures using multiple dilations is the standard of care for symptomatic relief and cure. Diverse arrays of techniques have been developed with similar success rates. In this study we suggest the use of urologic dilator as a safe, alternative method for the management of esophageal strictures. We report a case of a patient with a history of severe, recurrent esophageal stricture secondary to tracheo-esophageal fistula repair, treated using Amplatz urologic dilators and double J stent as a mechanical temporizer for an esophageal stricture at risk for complete stenosis. Under general anesthesia, a flexible endoscope was passed into the proximal esophagus to visualize the stricture. A glide wire was passed through the stricture and its placement was confirmed by fluoroscopy. The endoscope was then removed and a series of urologic dilators sizing from 12Fr to 32Fr were passed through the stricture under fluoroscopic vision. Following this, a double “J” stent was left in place for further dilation sessions and to prevent complete stenosis. In conclusion, urologic dilators demonstrate a novel and simple technique for the treatment of esophageal strictures. This patient had no reported complications, and patient was able to tolerate the double “J” stent during dilation sessions.