Severe high grade stenosing hyperkeratosis of the esophagus after ingestion of alkali: successful treatment by argon plasma coagulation.

reversible or irreversible lesions of the upper gastrointestinal tract [1]. In cases of alkali ingestion, esophageal strictures concomitant to dysphagia constitute a major problem of the long−term course. Regular follow−up by endoscopy is re− commended owing to the significantly increased risk of developing esophageal carcinoma [2]. In August 2005, a 71−year−old patient with serious dysphagia and known scarred esophageal stricture subsequent to ingestion of alkali presented for further diagnosis and treatment. Esophagogra− phy (l" Fig. 1) showed an irregular lumi− nal constriction. During the initial esophagogastroscopy the stenosis (23 ± 32 cm from the inci− sors) proved impassable for the endo− scope (external diameter 5.9 mm, GIF− XP160; Olympus, Hamburg, Germany) (l" Fig. 2). Bougienage followed by balloon dilation was done over several sessions. However bougienage proved to be ineffective as the bougie bent due to the high resistance within the stenosis (l" Fig. 3). Despite these therapeutic approaches no positive clinical results could be achieved. After neoplasia had been ruled out, argon plasma coagulation (APC) was done in re− peated sessions to ablate the circular hy− perkeratoses (l" Fig. 4), using a high fre− quency device (40± 60 W, 0.5 ± 0.6 l / min; BOWA, Gomaringen, Germany). At the end of this treatment (l" Fig. 5), passage of the GIF−Q160 endoscope (9.8 mm) presented no problems. Initially an esophageal carcinoma had been suspected, but in multiple tissue biopsies the histopathological examina− tion revealed parts of a distinctively hy− perkeratotic squamous epithelium with basal cell proliferation without evidence of malignancy (l" Fig. 6). Using APC, successful desquamation of the hyperkeratotic areas, with re−epithe− lialization after thermal destruction of the tissue, was achieved. After comple− Severe high grade stenosing hyperkeratosis of the esophagus after ingestion of alkali: successful treatment by argon plasma coagulation