Stent placement for delayed conduit obstruction at hiatus after esophagectomy

We report a case of a 62-year-old male who presented with shortness of breath after having undergone a modified McKeown esophagectomy 6 months after induction chemotherapy for cT3N1 adenocarcinoma of the distal esophagus. A chest computed tomography demonstrated a dilated gastric conduit with evidence of hiatal obstruction and aspiration pneumonia (Fig. 1A). Patient was subsequently intubated for respiratory distress, but eventually extubated three days later. Barium esophagram revealed a dilated gastric conduit with poor emptying (Fig. 1B). Patient underwent endoscopic evaluation revealing a dilated conduit with extensive food and gastric debris. The pylorus was found to be widely patent. However at the level of the hiatus just proximal to the pylorus, there was evidence of obstruction with passage of gastric contents impeded by redundant gastric conduit that formed a shelf at the hiatus with a resulting valve-like effect. A 10 cm × 18 mm AlimaxxTM stent was then placed across the area obstructed by the flap to just proximal to the pylorus (Fig. 1C). The area of obstruction was effectively opened with clearance of gastric content immediately evident. The patient subsequently underwent a barium swallow the succeeding day showing passage of contrast into the duodenum across the hiatus (Fig. 1D). The patient was started on clears and then was eventually discharged tolerating a soft solid diet. The patient remains free of obstructive symptoms for the past 12 months.