ASGE Postgraduate Course at ACG 2022: Expanding the Scope of Fundamental and Advanced Endoscopy (On-Demand)

deLatour_CASE Session 1

Pdf Summary

During Session 1, Dr. Rabia de Latour presented a case of a 50-year-old female with a poorly differentiated gastroesophageal (GE) junction adenocarcinoma. The patient had undergone FCMS placement and chemotherapy, resulting in a decrease in tumor size. However, a repeat CT scan revealed stent migration into the stomach. During the first endoscopy, a benign stricture was found at 33cm from the incisors, and attempts to remove the stent were unsuccessful. The patient then underwent a second endoscopy, during which a new stent was placed and the old stent was removed by pulling it through the lumen of the new stent.<br /><br />The take-home points from this case include the importance of securing covered esophageal metal stents to reduce migration risk, with larger diameter stents having a lower risk. Tumor shrinkage due to chemotherapy or radiation therapy can increase the risk of stent migration. Most esophageal stents can be removed by pulling on the lasso or loop on the proximal edge, but alternative methods such as using a double channel scope with rat tooth forceps or snare may be needed if a loop or lasso is not present. If the stent cannot be removed, leaving it in place may be an option for patients who are not surgical candidates.<br /><br />Dr. de Latour concluded the presentation by thanking the audience and providing her Twitter handle for further discussion.

Keywords

Dr. Rabia de Latour

gastroesophageal junction adenocarcinoma

FCMS placement

chemotherapy

tumor size decrease

stent migration

endoscopy

benign stricture

esophageal metal stents

surgical candidates