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Friends of Endoscopy is all about pattern recognition.  See it today and recognise it tomorrow!   Learn from a New Case on most weekdays !!! 
Become a Better Endoscopist ! 

An oesophageal stricture

27/3/2021

 
This patient has been referred for an oesophageal dilatation after biopsies have been reassuring
WHAT WOULD YOU DO?
■ Abort and take more samples
You are a wise as a fox!
■ Dilate to 12mm
Hmm, cautious but not cautious enought !
■ Dilate to 15mm
Seems reasonable but you've missed something!
■ Dilate to 18mm
You are clearly brave but look again!
■ Dilate to 20mm
If this stricture was benign, I would also aim for 20mm but it isn't!
explanation
Of course this stricture doesn't look right! There is a peculiar plaque-like area in the 10 O'clock position. The dilatation was cancelled and another set of samples were requested together with a CT. Samples indicated that this was a case of poorly differentiated intramucosal cancer and an EMR was organised.  Have a look at the clip below. Clearly this lesion is firmly tethered to underlying structures and is beyond endoscopic cure.  Some options may pop into your head such as injecting some fluid below the lesion or using the 'pull-within-the-snare' EMR technique.  The problem is that these will not change the basic fact that endoscopically the lesion is beyond endoscopic cure!  You run the risk of 'muddying the waters' with scrappy histology reporting 'intramucosal cancer at least' and with uncertain margins. Far better is to recognised the endoscopic irresectability of the lesion which provides a clear steer towards the 'next treatment level'. In this case the patient wasn't a surgical candidate and was offered chemo-radiotherapy (CRT). 

    Categories

    All
    Barrett's
    Cancer
    Cancer Syndromes
    Colitis
    Colorectum
    Corrosive Ingestion
    Crypt Pattern
    Difficulty: Hard
    Difficulty: Moderate
    Difficulty: Very Hard
    Duodenum
    Eosinophilic Oesophagitis
    EUS
    Foveolar Metaplasia
    Gastric
    Gastroscopy
    GI Bleeding
    Histology
    HPB
    Ileum
    Immunosuppression
    Infection
    Local Recurrence Of Barrett's Ca.
    Lymphoma
    Mixed Polyp
    Mucosal Prolapse Syndrome
    NET
    Non-lifting Sign
    Oesophagus
    Opinion Piece!
    Pharynx
    Polyp
    Polypectomy
    The Basics
    TSA

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