Massive Esophageal Hemorrhage From a Large Esophageal Tear Associated With Chronic Gastroesophageal Junction Stenosis Managed With Dual Overlapping Covered WallFlex Stents

Recurrent gastroesophageal (GE) junction stenosis and a Schatzki ring can rarely lead to severe esophageal injury and life-threatening bleeding. We describe a 68-year-old patient on apixaban with longstanding dysphagia requiring numerous prior esophageal dilations who presented with hematemesis and hemorrhagic shock from a large esophageal tear associated with pill impaction and severe distal esophageal narrowing. Initial endoscopic and radiologic interventions were unsuccessful in controlling the bleeding. Repeat endoscopy identified an extensive mucosal tear with ongoing hemorrhage, which was successfully managed with placement of dual overlapping fully covered esophageal stents under fluoroscopic guidance, spanning the injured segment and stenotic area. The patient recovered without recurrent bleeding and later underwent planned stent removal. This case highlights the potential complications of recurrent esophageal dilation and demonstrates the possible role of covered esophageal stents in the management of refractory non-variceal esophageal bleeding.