Ultrathin Endoscope-Assisted Wire-Guided Dilation for Radiation-Induced Esophageal Obstruction: A Case Report

We present a case of near-complete upper esophageal obstruction secondary to radiation necrosis in a patient with a history of hypopharyngeal squamous cell carcinoma treated with radiation and cisplatin/docetaxel chemotherapy. Standard endoscopic passage was not possible due to the absence of a visible lumen. An ERCP (endoscopic retrograde cholangiopancreatography) guidewire was advanced across the stenosis with moderate resistance, and using the wire as a guide, an ultrathin endoscope (4.9 mm; Olympus Corporation, Tokyo, Japan) was used as a dilator, achieving successful dilation to 10 mm and enabling passage into the middle third of the esophagus. Following the procedure, the patient tolerated a liquid diet and gained 13 pounds. Unlike prior reports in which the ultrathin endoscope served as an access tool followed by separate mechanical dilation or combined antegrade-retrograde dilation (CARD), in this case, the ultrathin endoscope itself functioned as the dilator, simplifying the procedure. This case highlights a resource-efficient approach to managing esophageal obstruction with an ultrathin endoscope as the dilator, offering a practical alternative in settings without access to fluoroscopy, stenting, or advanced interventional equipment. This technique may be most applicable to early inflammatory strictures rather than mature fibrostenotic ones. Findings are preliminary and based on a single case; further prospective studies are needed to establish safety, efficacy, and long-term outcomes.