An oesophageal stricture

This patient has been referred for a dilatation
WHAT IS THE AETIOLOGY OF THE STRICTURE?

■ Peptic stricture

Too membrane-like to be peptic

■ Schatzki ring

Of course it is - Well Done!

■ Eosinophilic oesophagitis

Strictures in EoE are long and tapered

■ Radiotherapy stricture

RXT strictures are at least a couple of cm in length

■ Malignant stricture

Of course it isn't !

explanation

This short almost membrane-like stricture is of course a Schatzki ring, named after the German-American physician Dr Richard Schatzki. It's usually easy to treat these with a balloon dilatation. This particular case is unusual as two dilatations were required.  However, rather than going ahead with a second dilatation to 20mm (our largest balloon in Leeds), I decided to cut the membrane with the tip of a snare and the diathermy set on the normal sphincterotomy setting. 

For this reason, I decided to 'cut' the membrane with the tip of a cheap snare which functions similarly to an Olympus 'FlexKnife' (at <1:20 of cost). I set the diathermy on the 'sphincterotomy' settings. Try to remember to only cut in the 6-9 o'clock quadrant. By rotating the shaft through the four quadrants you can then make 4-6 incisions.

The reason for only cutting close to the biopsy channel opening is that if you would work across your own field of view, the angle becomes too acute with the mucosa and you run the risk of cutting too deep. 

The uploaded video is a good example of this mishap when cutting across yourself.  I don't think that I perforated the full thickness of the oesophagus but applied a clip just in case (I've never regretted placing too many clips).