Resection of benign esophageal stricture through a minimally invasive endoscopic and transgastric approach

Recurrent benign esophageal strictures that are refractory to dilation can be difficult to manage. We report a novel technique for treatment of a recurrent esophageal stricture using a minimally invasive endoscopic and transgastric approach. The patient is a 40-year-old women who developed a recurrent distal esophageal stricture after repair of an esophageal perforation. Multiple prior dilations had been unsuccessful in achieving sustained esophageal patency, and the patient presented with a complete distal obstruction demonstrated on barium esophagram. Two flexible endoscopes were used: one placed through the mouth and another through a gastrostomy. While the transilluminated lesion was visualized from below the obstruction was traversed with an endoscopic aspiration needle from above. A guidewire was placed through the needle and pulled out the gastrostomy. Both the esophageal lesion and the gastrostomy tract were then serially dilated over the wire. After dilation the residual stricture was resected using a circular stapler placed through the dilated gastrostomy tract. After this procedure the patient maintained esophageal patency with a diminished need for dilation. Details of our technique are described and the literature is reviewed.