Endoscopic Treatment of a Cervical Esophageal Dissection Using a Polyflex Self-expanding Plastic Stent

68 INTRODUCTION A 69-year-old male presented to the otolaryngology clinic complaining of dysphagia. He had been diagnosed with T3N2bM0 squamous cell carcinoma of the hypopharynx one year prior. Direct laryngoscopy at that time demonstrated an extensive mass involving the right hypopharynx. Treatment consisted of induction chemotherapy followed by combined chemoradiation therapy. His course was complicated by hypopharyngeal stenosis resulting in dysphagia. This was initially managed successfully with a Maloney 60-French bougie dilator. Five months later, the patient presented to the otolaryngology clinic with recurrent dysphagia. On laryngoscopy, no distinct mass or stenosis was identified. Empiric serial dilation was performed up to a diameter of 60-French, with modest resistance encountered at the final dilation. Immediate endoscopic inspection demonstrated a patent esophageal inlet with mild bleeding, but no evidence of perforation. In the recovery area, the patient complained of severe chest pain, and a chest radiograph demonstrated moderate pneumomediastinum and pneumoperitoneum. An upper GI series was performed which showed an esophageal dissection originating in the cervical esophagus (Figure 1). The false lumen of the dissection extended down along the esophagus, exiting the outer wall of the distal esophagus with flow of contrast into the left lower lung parenchyma and pleural space (not shown). The patient was emergently brought to the operating room. On endoscopy, the entrance site of the false lumen could be seen just proximal to the thoracic inlet. The lumen of the false passage was the diameter of the 60-French bougie. The plane of dissection was between the submucosa and the muscularis propria, and the scope was passed along this plane until the exit Endoscopic Treatment of a Cervical Esophageal Dissection Using a Polyflex Self-expanding Plastic Stent A CASE REPORT