Two Cases of Refractory Benign Esophageal Stricture Treated With Laparoscopic Gastrojejunostomy After Esophageal Stenting

Background Endoscopic balloon dilatation is the first choice of treatment for benign esophageal stricture, but restenosis often occurs. The treatment of refractory benign esophageal stricture that does not improve after repeated balloon dilatations varies depending on the pathophysiology, but is often difficult to treat. In this report, we describe two cases of refractory benign esophageal stricture due to reflux esophagitis that were treated with laparoscopic gastrojejunostomy after stenting. Methods Case 1: An 81-year-old woman. She was referred to her local doctor with a chief complaint of dysphagia and suspected esophageal stricture due to type I esophageal hiatal hernia and GERD. After PPI administration and balloon dilatation without improvement, a fully-covered self-expandable metallic stent (fcSEMS) was inserted and implanted. Laparoscopic Toupet fundoplication was performed 8 days later. After resumption of oral intake, the patient did not complain of dysphagia and was able to take oral intake, and was discharged from the hospital. Results Case 2: A 60-year-old man was referred to our hospital after repeated balloon dilatations for short esophagus and esophageal stricture due to GERD. fcSEMS was inserted and laparoscopic Toupet fundoplication was performed 9 days later. The fcSEMS was removed on the 10th postoperative day. The patient had no symptoms of restenosis after stent removal and was discharged from the hospital. Conclusion Stenting of refractory benign esophageal stenosis improves the symptoms of stenosis during implantation, and oral intake is likely to be possible. However, prolonged stenting carries the risk of migration, bleeding, and in severe cases, esophageal fistula or perforation. In this case, the patient was treated with a fundoplication during stenting to prevent restenosis and to avoid the risks associated with stenting. There was only one similar report in PubMed research. We report two cases experienced at the same time in our department with literature review.