PMC9906806_01
(A-C) Morphology of esophagus under gastroscopy. (A) The upper esophagus was morphologically normal. (B) Circumferential stenosis was observed 34cm from the esophageal incisor (black arrow indicates lower esophageal ulcers). (C) Extreme stenosis was observed 37cm from the esophageal incisor so that the endoscope could not pass through. (D, E) Gastric morphology under ultrafine endoscopy. (D) The gastric body was covered with white moss, and easy to bleed while touching. (E) Normal peristalsis was absent and ulcers were seen in the gastric body (yellow arrow indicates gastric body ulcers).
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Circumferential stenosis of the lower esophagus was observed approximately 34-37 cm from the esophageal incisors ( Figures 1A-C ), with a brittle mucous membrane and tendency to bleed while touching; the remaining esophageal mucosa was smooth with a clear vascular texture. The surface of the gastric wall was covered with white moss and bled easily while touching, with ulcers visible in the gastric body ( Figures 1D, E ).
Upper gastrointestinal iodine angiography showed significant stenosis of the gastric cavity. (A, B) Anteroposterior views of the upper gastrointestinal iodine angiography. (C) Lateral views of the upper gastrointestinal iodine angiography.
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Upper gastrointestinal iodine angiography was recommended by the gastroenterologist, which showed an irregular shape of the stomach and obvious gastric stricture ( Figure 2 ) with gastroesophageal reflux.
Pathological manifestation at the site of stenosis. (A) A patch of smooth muscle tissue with small foci of calcifications (arrows indicate the calcifications). (B) A patch of small blood vessels, nerve and hyperplasia of fibrous tissue with inflammatory cell infiltration (inflammatory and fibrous cells were scattered, black andred rectangles indicate relatively obvious inflammatory and fibrous cell aggregates, respectively).
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The results showed a patch of smooth muscle tissue with small foci of calcifications, and a patch of small blood vessels, nerve, and hyperplasia of fibrous tissue with inflammatory cell infiltration, which were considered to be reactive changes ( Figure 3 ); no carcinoma was found.
(A-C) Cardiac morphology before (A), during (B) and after (C) laser incision. (D-F) Cardiac morphology before (D), during (E) and after (F) bouginage.
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Five months later (July 2021), when the patient's nutritional status improved, laser incision of the stenosis site under gastroscopy was performed ( Figures 4A-C ). Bouginage of the esophago-cardiac stenosis was performed ( Figures 4D-F ); 5 mm, 7 mm, 9 mm, and 11 mm zebra guidewires were used for continuous expansion for 1 min each, with an interval of 1 min.