A 68-year-old man presented to our hospital with progressive dysphagia and retrosternal
discomfort for 1 month. Endoscopy and pathological biopsy confirmed invasive squamous
cell carcinoma of the distal esophagus ([Fig. 1 ]
a ) and poorly differentiated adenocarcinoma at the junction of the gastric antrum and
body ([Fig. 1 ]
b ). Following preoperative preparation, the patient underwent subtotal esophagectomy,
gastrectomy, and anterograde ileo-colon interposition for esophageal replacement via
the retrosternal route.
Fig. 1
a Endoscopic image of invasive squamous cell carcinoma in the distal esophagus. b Poorly differentiated adenocarcinoma at the junction of the gastric antrum and body.
c–d Esophagogram revealed tortuous angulation of the cervical esophago-ileal anastomosis.
e Intestinal villi identified by intraluminal saline irrigation. f Endoscopic balloon dilation.
On postoperative day 44, an esophagogram revealed tortuous angulation at the cervical
esophago-ileal anastomosis ([Fig. 1 ]
c, d ). On postoperative day 65, the patient started experiencing difficulty swallowing
water due to an anastomotic stenosis with a diameter less than 5 mm, as revealed by
endoscopy. The initial attempt at endoscopic balloon dilation failed because the guidewire
could not be advanced under direct visualization.
Subsequently, radiation-free mother-baby endoscopic balloon dilation using a TY-ISS-L31
catheter (outer diameter: 3.1 mm; Vedkang, Changzhou, China) was planned ([Video 1 ]). The catheter was introduced through the working channel of a therapeutic endoscope
(GIF-1T240; inner channel diameter: 4.2 mm; Olympus, Tokyo, Japan) and positioned
at the anastomotic site. The catheter was then advanced slowly into the ileal lumen
until the guidewire reached the cecum. Intestinal villi were visualized during insertion
using intraluminal saline irrigation ([Fig. 1 ]
e ).
Radiation-free mother-baby endoscopic balloon dilation performed for cervical esophago-ileal
anastomotic stenosis in a 68-year-old man.Video 1
The TY-ISS-L31 catheter was subsequently withdrawn, leaving the guidewire in place.
A balloon (12–13.5–15 mm; Micro-Tech, Nanjing, China) was inserted over the guidewire
to dilate the cervical anastomosis ([Fig. 1 ]
f ). Post-procedure, the conventional endoscope passed through the cervical anastomosis
and ileocecal valve without resistance.
This report highlights the first use of a mother-baby endoscopic technique, without
fluoroscopic guidance, to dilate an angulated esophago-ileal anastomosis. This balloon
dilation approach exclusively using endoscopy avoids radiation exposure for both patients
and medical personnel, making it particularly beneficial for radiation-intolerant
patients or institutions lacking fluoroscopic equipment. This novel technique expands
the possibilities for radiation-free endoscopic procedures in confined anatomical
spaces [1 ]
[2 ]
[3 ].
Endoscopy_UCTN_Code_CCL_1AB_2AC_3AD
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