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Year : 2016  |  Volume : 1  |  Issue : 2  |  Page : 64-66

Esophageal diverticulum and high-grade esophageal stricture responsive to serial balloon dilation and nutritional therapy

University of South Florida Morsani College of Medicine, 12901 Bruce B Downs Blvd, Tampa, FL 33612, United States

Correspondence Address:
Joseph Spuches
University of South Florida Morsani College of Medicine, 12901 Bruce B Downs Blvd, Tampa, FL 33612
United States
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Source of Support: None, Conflict of Interest: None

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Aims: 16 year old boy withrecessive dystrophic epidermolysisbullosa and previous history of esophageal strictures presents with progressive dysphagia and hematemesis. Patient was admitted to hospital to determine cause of hematemesis. Methods: Patient underwent endoscopy using Olympus GIF-XP 160 endoscope. Results: Endoscopy revealed active esophagitis and multiple blood clots. A high-grade esophageal stricture was noted at level 35cm from incisors, in which the endoscope (5.9 mm diameter insertion tube) could not pass. Endoscopy two days later revealed an esophageal diverticulum and bifurcation located 35cm from the incisors. Instilling a small amount of water revealed a blind ended sac on the left side and a lumen leading to the stomach on the right side (see image). The true esophageal lumen was dilated using a 6-7-8mm CRE™ Wire guided Balloon Dilator (Boston Scientific). He was treated with nutritional therapy (TPN, then enteral feedings following gastrostomy placement by interventional radiology), sucalafate, ranitidine, and zinc. Three subsequent endoscopic dilationsincreased the true lumen diameter to 15 mm. Follow-up esophagram revealed a notably smaller esophageal diverticulum and a small amount of mediastinal air, suggesting microscopic esophageal perforation treated conservatively with IV antibiotics. Conclusion: EGD three months later showed no residual esophageal stricture and complete resolution of the esophageal diverticulum. Balloon dilation along with management of nutrition have been shown to be effective and safe methods of treating esophageal strictures in children, and in this case has been effective in managing an esophageal diverticulum.

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