ASGE Postgraduate Course at ACG 2022: Expanding the Scope of Fundamental and Advanced Endoscopy

deLatour_CASE Session 1

Pdf Summary

In this case presentation, a 50-year-old female with a diagnosis of poorly differentiated gastroesophageal junction adenocarcinoma presented with worsening dysphagia and weight loss. She underwent various treatments, including the placement of a fully covered self-expandable metal stent (FCMS) and chemotherapy. Repeat imaging showed a decrease in tumor size with chemotherapy, and the plan was to advance the diet and potentially remove the stent and surgical J tube. However, repeat CT imaging revealed stent migration into the stomach, leading to the need for stent removal.<br /><br />During the first endoscopy, a benign appearing fibrotic stricture was found at 33cm from the incisors, but a subsequent examination with a different scope revealed malignant tissue distal to the stricture. The initial stent failed to collapse, making it difficult to remove. The patient declined a new stent placement at that time.<br /><br />One month later, a new procedure was scheduled. During the second endoscopy, a wire was placed into the stomach lumen, and a new stent was inserted to create a pathway for the removal of the old stent. The new stent was dilated, allowing for traversal of an adult gastroscope. The old stent was then pulled through the lumen of the new stent and removed.<br /><br />The take-home points from this case include the importance of securing covered esophageal metal stents, the known risk of stent migration in palliative esophageal stent placement, the impact of tumor shrinkage on migration risk, and various techniques for stent removal. It is also noted that leaving the stent in place may be an option if unable to remove it.<br /><br />The presenter also disclosed financial relationships with Boston Scientific and Ambu, Inc.

Keywords

poorly differentiated gastroesophageal junction adenocarcinoma

dysphagia

weight loss

fully covered self-expandable metal stent

chemotherapy

tumor size decrease

stent migration

benign fibrotic stricture

malignant tissue

stent removal