Tight near-total corrosive strictures of the proximal esophagus with concomitant involvement of the hypopharynx: Flexible endoscopic management using a novel technique

Table 1 Demographic details, radiological and endoscopic findings, and outcomes of the 2 patients with near-total strictures of the pharyngo-esophagus treated by the flexible endoscopic technique

		Case 1	Case 2
Demographic details	Age/Sex	37/F	42/M
	BMI (kg/m2) at presentation	13.2	15.6
	Acid consumed	Sulphuric acid	Nitric acid
	Time since acid was consumed	4 mo	11 mo
	No. of strictures on esophagogram	1	2
	Approximate length of stricture	3.5 cm	4 cm (proximal stricture)
			5 mm (distal stricture)
	Near-total stricture communicated with which piriform sinus	Right piriform sinus	Right piriform sinus
	Concomitant gastric stricture	No	No
	Whether feeding jejunostomy was performed?	No	No
Endoscopic procedural details	Time taken for the passage of guide-wire across the stricture	First session: Failed	14 min
		Second session: 22 min
	Dilatation details
	First balloon dilatation till	6 mm	6 mm
	No. of dilatations to reach 14 mm	3	4
	Residual stricture after dilatation on esophagogram	Yes	Proximal stricture: Yes
			Distal stricture: No
	Time taken for electro-incision	12 min	10 min
Primary outcome	Complete relief of dysphagia along with the resolution of stricture(s) on esophagogram and endoscopy, performed after 2 wk of full endoscopic therapy	Yes	Yes
Secondary outcomes	Intraprocedural complication	None	None
	Post-procedural complication	None	None
	Duration of the follow-up	22 mo	14 mo
	Improvement in activities after the procedure	Yes	Yes
	Recurrence of dysphagia during the follow-up or any need of additional therapy	No	No
	Any regurgitation episode during the follow-up	No	No
	Any aspiration episode during the follow-up	No	No
	BMI at last follow-up (kg/m2)	21.6	23.8

BMI: Body mass index; F: female; M: Male.

Table 2 Comparison of the open surgical, rigid endoscopic and flexible endoscopic techniques for the management of the near-total hypopharyngeal strictures

	Surgery	Rigid Endoscopy	Flexible Endoscopy
Hospital admission	Required	Required	Not required
Performed by	Gastro-surgeons in the operation theatres	ENT surgeons in the operation theatres	Gastroenterologists or surgical endoscopists in the endoscopy suites
Hyper-extension of the patient’s neck	Not required	Required	Not required
Type of anesthesia given	General anesthesia	General anesthesia	Conscious sedation
Anesthetic and procedural time	Longest	Long	Short
External incision over the neck or chest wall	External incision is given. This predisposes to post-operative complications like fistula, wound infection and hematoma formation	Not given	Not given
Concomitant esophageal cicatrisation	Can be tackled	Cannot be tackled	Can be tackled
Clinical recovery after the procedure	Slow	Intermediate	Quick
Morbidity and mortality associated with the technique	High	Low	Least
Contraindications	Elderly patients with comorbidities	Short neck	None
	Severe malnutrition	Retrognathia
	Inability to give general anesthesia	Inability to give general anesthesia
Experience with the procedure till date	Maximum	Limited	Limited