Endoscopic Suturing of Esophageal Stent

Dipti Sagar, Subramanyeswara Arekapudi, Sachdev Thomas, Helen Wong and Shreyas Saligram

Endoscopic Suturing of Esophageal Stent

Migration is the most common complication of placing an esophageal fully
covered self-expanding metal stent.
Prior Studies have demonstrated high migration rates of FCSEMS leading
to additional invasive procedures.

We report a case of esophageal FCSEMS placement with endoscopic
suturing which prevented migration of the stent and a successful post procedure course.

A 68-year-old male presented with complaints of heartburn and progressive
dysphagia for solid food.

His past medical history was remarkable for coronary artery disease with
coronary stent placement in 2008 and 2009 and gastroesophageal reflux disease.

His family history was significant for esophageal cancer in brother diagnosed
at the age of 53 years. Physical examination was significant for epigastric tenderness
but the rest of the examination was otherwise unremarkable.

Labs were significant for iron deficiency anemia: hemoglobulin 10.3 gm/dL,
hematocrit 31.1%, MCV 87%, iron 24 mcg/dL, transferrin saturation 7 mcg/dL.

A computed tomography scan of abdomen and pelvis with
contrast performed to evaluate iron deficiency anemia showed
marked circumferential thickening of the visualized portion of the
distal esophagus extending to the gastroesophageal GE junction,
which was suspicious for esophageal cancer.

There was an enlarged lymph node of the gastro-hepatic ligament suspicious for metastasis.
Upper endoscopy was performed which showed a large, fungating and ulcerating mass with no bleeding in the mid and distal esophagus.

The mass was partially obstructing and circumferential.
It extended from mid esophagus to GE junction.

Gastro Open J. 2018; 3(1): 1-3. doi: 10.17140/GOJ-3-127