New Endoscopic Solutions in Managing Phlegmonous Esophagitis

A 48-years-old woman was admitted in the emergency department due epigastric pain, vomiting and cough. She presented with fever and increased inflammatory parameters. A thoracoabdominal computed-tomography (CT) was performed and revealed thickening of the gastric fundus and esophagus, with an apparent laceration in esophageal mucosa and associated dissection of esophageal wall. In upper endoscopy (UE), a bulging of esophageal and gastric walls was observed, with an ulceration in proximal esophagus, suggestive of a perforation. After multidisciplinary discussion, a minimally invasive endoscopic approach was decided. Internal esophageal drainage (IED) was assured with performance of some incisions with Dual-knife ® (Olympus,Tokyo) along the mucosal and submucosal layers in the esophagus. During the incision, extravasation of pus was evident. One week later, due to clinical worsening and evidence of esophageal perforation in CT scan, UE was repeated. We confirmed esophageal perforation with visualization of two millimetric defects in the proximal esophagus. Significant bulging of the gastric fundus and body was also observed. IED was repeated with mucosal incision of the gastric bulging using Needle-Cut 3V® (Olympus, Tokyo), with extravasation of a significant quantity of pus. We decided to proceed to endoscopic vacuum therapy was performed with sponge placement in the esophageal lumen (Endosponge®, B.Braun,Melsungen,Germany). UE was repeated one week later with sponge remova...
Source: Digestive Diseases - Category: Gastroenterology Source Type: research