P155 What goes down must go up: a difficult oesophageal stent insertion

Introduction

An 80 year old man was diagnosed with an advanced distal oesophageal adenocarcinoma. He was referred for a palliative oesophageal stent due to marked dysphagia. An initial attempt at stent insertion was curtailed by an unexpectedly complex, incarcerated hiatus hernia which was not highlighted on the CT report. As there was tight angulation of the hiatus hernia just below the gastro-oesophageal junction (GOJ) and concerns of stent impaction, the procedure was abandoned. Following review, a repeat attempt was arranged as he had few other options for nutrition. During the repeat attempt, a nasoendoscope was used to traverse the tumour and carefully navigated through a loop in the hiatus hernia into the antrum. A stiff amplatz wire was then placed and the distal margin of the tumour at the GOJ was marked with an external paperclip. A 10cm half-covered Citec oesophageal stent was placed with the distal flange deployed immediately below the GOJ. The distal flange was inspected with a nasoendoscope and the stent was then pulled upwards using grasping forceps. Contrast instillation confirmed smooth passage through the stent and hiatus hernia into the gastric body. The patient’s symptoms improved and he was discharged.

Conclusion

We demonstrate the challenges in oesophageal stent placement in a patient with a complex incarcerated hiatus hernia and technique modifications. Video link: HH stent_BSG (vimeo.com)