This case is entitled EOS-Guided Esophago-Esophagostomy in a Patient with Complete Esophageal Obstruction. The authors are Mark Redlinsky, Wissam Bliebel, and Vanessa Shami. This case is of an 81-year-old woman who has undergone serial dilations for a benign intrinsic esophageal stricture at 29 centimeters from the incisors. She's been unable to tolerate any solid or liquid intake, and she has a surgically-placed direct J-tube by which she receives most of her nutrition. Endoscopic methods involved in this case include a linear and forward-viewing echoendoscope that were used to create an EOS-Guided Esophago-Esophagostomy, along with an esophageal stent placed over a wire to bridge the obstructed proximal and distal esophagus. As previously described, the patient has a benign intrinsic stenosis located at 29 centimeters from the incisors. Two months prior to presentation, the patient was admitted for hematemesis. Endoscopy at this time was notable for a superficial esophageal ulcer, which was actively oozing. Fulguration to stop the bleeding was performed on several areas with hot biopsy forceps. After coagulation, a single endoscopic clip was placed over the ulcerated area. Given continued bleeding, a hemostatic spray was used, and hemostasis was achieved. On follow-up endoscopy two months later, the patient was noted to have a completely obstructed stenosis, which was at the site of the prior ulceration and prior intrinsic stenosis. A linear echoendoscope was then advanced to the obstructed esophagus. Wall thickening was visualized endosonographically in the thoracic esophagus, and the wall was noted to be 1.47 centimeters. Using a 19-gauge needle, we were able to access the distal esophageal lumen, which was confirmed under fluoroscopy with contrast. We advanced a 0.35-millimeter wire fluoroscopically to the stomach. We then exchanged for a diagnostic scope and noted that the 0.35 wire was not ideally positioned. The wire went through the esophageal wall 2 centimeters proximal to the complete stenosis. Therefore, we left the wire for reference and placed another wire using a forward-viewing echoendoscope. The distal esophagus was again accessed, and the wire was positioned on FOS with the obstruction. A 4-millimeter biliary balloon was then used to create a track between the distal and the proximal esophageal lumen. An esophageal stent was then deployed, bridging the proximal and distal esophagus. The stent was 14 millimeters by 119 millimeters. An esophogram at the end of the procedure revealed there was no contrast extravasation, and there was bridging between the proximal and distal esophageal lumens. Endoscopic examination 2 months afterward showed healing of the esophagoesophagostomy following the esophageal stent removal. This is a case of a complete esophageal obstruction secondary to a benign esophageal stricture. A forward-viewing echoendoscope can be useful in approximating the proximal and distal esophagus in plain from U.S.-guided esophagoesophagostomy.

esophageal obstruction

benign esophageal stricture

endoscopic methods

EOS-Guided Esophago-Esophagostomy

esophageal stent