Endoscopic Suturing of Esophageal Stent

A 68-year-old male presented with complaints of heartburn and progressive dysphagia for solid food. His past medical history was remarkable for coronary artery disease with coronary stent placement in 2008 and 2009 and gastroesophageal reflux disease (GERD). His family history was significant for esophageal cancer in brother diagnosed at the age of 53 years. Physical examination was significant for epigastric tenderness but the rest of the examination was otherwise unremarkable. Labs were significant for iron deficiency anemia: hemoglobulin 10.3 gm/dL, hematocrit 31.1%, MCV 87%, iron 24 mcg/dL, transferrin saturation 7 mcg/dL. A computed tomography (CT) scan of abdomen and pelvis with contrast performed to evaluate iron deficiency anemia showed marked circumferential thickening of the visualized portion of the distal esophagus extending to the gastroesophageal GE junction, which was suspicious for esophageal cancer. There was an enlarged lymph node of the gastro-hepatic ligament suspicious for metastasis. Upper endoscopy was performed which showed a large, fungating and ulcerating mass with no bleeding in the mid and distal esophagus. The mass was partially obstructing and circumferential. It extended from mid esophagus to GE junction (Figure 1). Biopsies were taken with cold forceps for histology, which showed poorly differentiated adenocarcinoma with signet-ring cell type with background of Barrett’s esophagus with high-grade dysplasia and positive Her2/neu overexpression by immunohistochemistry stain.