Case Capsule 4 ENDOSCOPIC DIAGNOSIS, STAGING AND PALLIATION OF MALIGNANT DYSPHAGIA A 53yrs Female, was referred to us with a diagnosis

of poorly differentiated Squamous Carcinoma of Lower 1/3rd Esophagus for Staging sos Palliation of absolute Dysphagia with severe Comorbidities. Endoscopic & EUS staging showed T3N2Mx. Since patient was reluctant for neoadjuvant treatment, a Self Expandable Covered Antireflux Metal Stent was then placed across the stricture after Balloon Dilatation under Endoscopic & Fluoroscopic control. Patient started taking oral feeds few hours after stent placement and was sent home the same evening uneventfully.

-----------------------------------------------------------------------------------------------------------Endoscopy Asia 2nd Floor, Lion Tarachand Bapa Hospital Marg,Jain Society, Sion (West),Mumbai 400 022, India. Contact No (09:30 - 20:30) 022 2404 3522 / 2404 4680, 3208 8827 / 8 / 9 | Emergency (08:30 - 23:30) +91 93200 91763 / 98200 91763 | Email: enquiry@endoscopyasia.com |Telefax: 022 2404 4680

1. A large ulceroproliferative 2. A large ulceroproliferative stemotic lesion at 35cms from the stemotic lesion at 35cms from the incisors teeth. incisors teeth.

3. Balloon dilatation was performed.

4. The lesion seems to have invaded the cardia on retroflexion

-----------------------------------------------------------------------------------------------------------Endoscopy Asia 2nd Floor, Lion Tarachand Bapa Hospital Marg,Jain Society, Sion (West),Mumbai 400 022, India. Contact No (09:30 - 20:30) 022 2404 3522 / 2404 4680, 3208 8827 / 8 / 9 | Emergency (08:30 - 23:30) +91 93200 91763 / 98200 91763 | Email: enquiry@endoscopyasia.com |Telefax: 022 2404 4680

5. EUS staging showed T3N2Mx.

6. A self expandable covered antireflux metal stent was deployed across the stricture.

7. Optimal stent deployment was confirmed on constrast study on fluroscopy

-----------------------------------------------------------------------------------------------------------Endoscopy Asia 2nd Floor, Lion Tarachand Bapa Hospital Marg,Jain Society, Sion (West),Mumbai 400 022, India. Contact No (09:30 - 20:30) 022 2404 3522 / 2404 4680, 3208 8827 / 8 / 9 | Emergency (08:30 - 23:30) +91 93200 91763 / 98200 91763 | Email: enquiry@endoscopyasia.com |Telefax: 022 2404 4680

Expert Comments : As we can see in this case, patient with absolute dysphagia due to advanced lower 1/3rd esophageal malignancy with extensive nodal metastasis, who is a poor surgical risk and who does not want neoadjuvant treatment. We feel that this approach of Endoscopic staging and palliation with a metallic stent placement was ideal in such a patient. The procedure was done on a daycare basis and patient was sent home the same day.

-----------------------------------------------------------------------------------------------------------Endoscopy Asia 2nd Floor, Lion Tarachand Bapa Hospital Marg,Jain Society, Sion (West),Mumbai 400 022, India. Contact No (09:30 - 20:30) 022 2404 3522 / 2404 4680, 3208 8827 / 8 / 9 | Emergency (08:30 - 23:30) +91 93200 91763 / 98200 91763 | Email: enquiry@endoscopyasia.com |Telefax: 022 2404 4680