ASGE Esophagology: Tailoring Management from Testing to Treatment (On-Demand) | July 2022-CASE Based Discussion Session 6

Video Transcription

Video Summary

In this video, a case of a 56-year-old woman with a history of atrial fibrillation and GERD is presented. She complains of dysphagia, which has progressively worsened over five years. Initial endoscopies were considered non-diagnostic, showing chronic inflammation. However, a subsequent endoscopy revealed characteristic lesions of lichen planus in the esophagus. The video demonstrates the removal of the desquamated tissue, resembling snake skin, in the esophagus using a scope. The speaker discusses the underdiagnosis of esophageal lichen planus, often misdiagnosed as EOE, lymphocytic esophagitis, idiopathic strictures, or reflux disease. The management of esophageal lichen planus is challenging, with no established guidelines or consensus. Swallowed topical steroids, systemic therapy, intermittent dilations, and other agents have been tried with varying success rates. Dentists often diagnose oral involvement of lichen planus, which may be present without cutaneous manifestations. Esophageal lichen planus can lead to strictures and increases the risk of squamous cell carcinoma. Surveillance is necessary, but the frequency is not well-defined. Further research is needed to determine the optimal treatment approach for esophageal lichen planus.

Asset Subtitle

The Spectrum of the Lichenoid Esophagus
Refractory EoE

Keywords

atrial fibrillation

GERD

dysphagia

lichen planus

esophagus