Endoscopic ultrasound-guided recanalization of a complete esophageal stricture. These are our disclosures. A 34-year-old male with long-standing gastroesophageal reflux disease and recurrent esophageal strictures presented for evaluation of dysphagia. His last EGD with dilation was five months prior to his presentation to our facility where a through-the-scope balloon dilation was performed up to 8 mm. A surgically placed G-tube was also performed due to significant weight loss and malnutrition. An upper endoscopy was performed which revealed a large amount of liquid and solid food particles. These were carefully suctioned and removed to allow complete visualization of the esophageal lumen. A blind end was noted in the distal esophagus without a clear lumen to allow for routine dilation. The patient was then referred to the interventional endoscopy team. Under general anesthesia in the supine position, the findings from the upper endoscopy was confirmed fluoroscopically by injecting a large amount of contrast, none of which passed through to the gastric lumen. A therapeutic linear echoendoscope was then inserted and used to evaluate the esophagus, stomach and surrounding structures. At this point, a clear window to target a recanalization attempt could not be achieved. In an attempt to localize a window, the previously placed G-tube was used for sterile water irrigation using the foot pedal. A total of 3 liters was instilled into the gastric lumen. This allowed for clear visualization of the gastric lumen and surrounding structures. The decision was then made to proceed with luminoposing metal stand placement under fluoroscopic and endoscenographic guidance. Once a clear window, clear of any intervening vessels, using Doppler ultrasound was achieved, a 19-gauge needle puncture was performed, and a long 0.025 guide wire was inserted and visualized fluoroscopically with coiling evident in the stomach. A 10x10 luminoposing metal stand and its electrocautery tip was introduced through the working channel, electrocautery was applied, and the device was then advanced over the guide wire. The stent was then deployed with close approximation of the esophageal and gastric lumen. A large amount of fluid was suctioned through the luminoposing metal stent, which was then dilated using the through-the-scope balloon up to 10 mm. On follow-up 4 weeks later, the patient is tolerating a soft diet and has gained 16 pounds since the procedure. In conclusion, EUS-guided recanalization using luminoposing metal stents are efficacious and safe options for patients with complete esophageal strictures. These interventions may prevent the need for more invasive surgical procedures.

gastroesophageal reflux disease

esophageal strictures

balloon dilation

G-tube placement

endoscopic ultrasound-guided recanalization