Novel, double-lumen removable stent to treat caustic esophageal stenosis.

Recurrent esophageal stenosis following caustic injury may be difficult to treat. A tube stent developed at our institution [1] can be used as an alternative to repetitive endoscopic esophageal stricture dilation. The case of a boy with severe larynx and esophageal caustic injury at the age of 2 years is reported here. Endoscopy (●" Fig.1a) and radiography (●" Fig.2a) performed 3 weeks after the accident showed esophageal stenosis. Within the subsequent 4 months, the patient underwent six endoscopic esophageal Savary–Gillard bougienage dilation procedures (up to 7–9mm) under radiographic control (●" Fig.2b) without longterm restoration of the esophageal lumen. At 5 months, esophageal stenosis was still present (●" Fig.1b) and the patient tolerated only a liquid diet. Thus, the patient underwent implantation of a double-lumen, variable-diameter, perforated nasogastric tube stent (●" Fig.3) under radiographic control (●" Fig.2c). Tolerability of the tube was satisfactory. The patient accepted the proximal end of the tube extending from the nose, tolerated a semiliquid diet, and gained weight without the need for additional gastric tube feeding (●" Fig.4). The tubewas removed after 5months, and endoscopy showed restoration of the esophageal lumen (●" Fig.1c). At 6months after tube stent removal, the patient tolerated a normal diet and gained weight (●" Fig.4). Radiography showed no esophageal stenosis (●" Fig.2d), and endoscopy revealed rigidity and cicatrization of the Fig.2 Radiographs of the esophagus. a 3 weeks after chemical injury (Dec 2012), stenosis and an irregular esophageal wall were observed. b Endoscopic esophageal Savary–Gillard 7-mm dilation 5 weeks after chemical injury (Dec 2012); the esophageal stricture length was two vertebrae. c Tube stent placement (Apr 2013): 1=marker indicating the upper stenosis border; 2=marker indicating the upper margin of the main part of the tube stent; 3=marker indicating the lower margin of the main part of the tube stent. d 6 months after tube stent removal (Mar 2014), the esophagus without stenosis.