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A 54-year-old man underwent a proximal gastrectomy with partial esophagectomy to treat a carcinoma of the cardia 5 years ago. A persistent postoperative fistula of the esophago-gastric anastomosis occurred, which required a second surgery 4 years ago during which a colon interposition was performed. After surgery, stricture of the esophagus-colonic anastomosis developed 2cm distal from the upper esophageal sphincter, causing grade 3 dysphagia for which the patient underwent multiple dilations with Savary–Gilliard bougies. As the stenosis was deemed refractory to serial dilations, a biodegradable esophageal stent (BD stent 019-10A23/18/23-060; SX-ELLA, Hradec Kralove, Czech Republic) was placed 1 year ago (●" Fig.1). Although transient improvement was noticed, the patient experienced recurrent dysphagia 1 month later and required further dilations 4 months later. Hence, a 4cm diabolo-shaped, covered, biliary, self-expandable metallic stent (SEMS; Hanarostent BCF-10-040-180; M.I. Tech Co., Seoul, Korea), 10mm in diameter and with flares 5mm long and 24mm in diameter, was placed under direct and fluoroscopic view (●" Fig.2, ●" Fig.3, ●" Fig.4) using a therapeutic channel endoscope (GIF 2T130; Olympus, Tokyo, Japan). The stent was well tolerated and the patient noticed an immediate substantial improvement from grade 3 to grade 1 dysphagia. The stent was exchanged three more times at 8-week intervals using the proxiFig.1 Radiologic view showing a biodegradable esophageal stent placed to treat a refractory esophagus-colonic stricture.

Utilization of diabolo-shaped covered biliary stents in a refractory esophagus-colonic anastomotic stricture