Ann Rehabil Med.  2014 Aug;38(4):581-584. 10.5535/arm.2014.38.4.581.

Balloon Dilatation for an Esophageal Stricture by Long-Term Use of a Nasogastric Tube: A Case Report

• Yoon YS
• Kim JY
• Lee KJ
• Yu KP
• Lee MS

• KMID: 2165744
• DOI: http://doi.org/10.5535/arm.2014.38.4.581

Abstract

In the present report, we describe a case of long-term follow-up esophageal stricture occurring in a patient with nasogastric tube use. A 63-year-old man who had experienced dislocation of the 6th and 7th cervical vertebrae as the result of an external injury received treatment at another hospital and was admitted to the rehabilitation department of our hospital. After he exhibited normal swallowing in a videofluoroscopic swallowing test, the nasogastric tube was removed and oral feeding with a dysphagia diet was initiated. However, during oral feeding, the patient complained of swallowing difficulties in his lower throat. An esophagogastroduodenoscopy was performed to examine the lesions below the pharynx and a 2-mm stricture was observed. A balloon dilatation was performed for a total of 9 times to extend the stricture. After the procedure, the patient was able to easily swallow a normal diet through the esophagus and the vomiting symptoms disappeared. An esophagography showed that the diameter of the esophageal stricture was 11 mm.

Keyword

Nasogastric tube; Esophageal stricture; Ballooning dilatation

MeSH Terms

Cervical Vertebrae
Constriction, Pathologic
Deglutition
Deglutition Disorders
Diet
Dilatation*
Dislocations
Endoscopy, Digestive System
Esophageal Stenosis*
Esophagus
Female
Follow-Up Studies
Humans
Middle Aged
Pharynx
Rehabilitation
Vomiting

Figure

• 

  Fig. 1 Esophagogastroduodenoscopy: a stricture is visible 35 cm below the inferior pharyngeal constrictor muscle.

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  Fig. 2 (A) Esophagogram before balloon dilatation: the stricture lumen is approximately 0.2 cm in length. (B) After 4 applications of balloon dilatation, a slight dilatation is observed and the stricture lumen is approximately 0.5 cm in length. The drainage of the contrast medium is improved, but the stricture within the mid-esophagus persists.

• 

  Fig. 3 Follow-up with the Functional Oral Intake Scale, and stricture diameter after repeated ballooning dilatations.

Reference

1. Kirby DF, Delegge MH, Fleming CR. American Gastroenterological Association technical review on tube feeding for enteral nutrition. Gastroenterology. 1995; 108:1282–1301. PMID: 7698596.

2. Pancorbo-Hidalgo PL, Garcia-Fernandez FP, Ramirez-Perez C. Complications associated with enteral nutrition by nasogastric tube in an internal medicine unit. J Clin Nurs. 2001; 10:482–490. PMID: 11822496.

3. Groher ME, Crary MA. Dysphagia: clinical management in adults and children. 1st ed. Philadelphia: Mosby;2010. p. 308–322.

4. Banfield WJ, Hurwitz AL. Esophageal stricture associated with nasogastric intubation. Arch Intern Med. 1974; 134:1083–1086. PMID: 4433188.

5. Zaninotto G, Bonavina L, Pianalto S, Fassina A, Ancona E. Esophageal strictures following nasogastric intubation. Int Surg. 1986; 71:100–103. PMID: 3733352.

6. Nam BH, Kang YW. Endoscopic balloon dilatation for benign and malignant esophageal strictures. Korean J Med. 1995; 48:200–206.

7. Yang US, Park SK, Kang DH, Song CS, Cho M, Song GA. The effect of bougie and balloon dilatation on benign esophageal stricture. Korean J Med. 1998; 54:660–665.

8. Crary MA, Mann GD, Groher ME. Initial psychometric assessment of a functional oral intake scale for dysphagia in stroke patients. Arch Phys Med Rehabil. 2005; 86:1516–1520. PMID: 16084801.

9. Nagler R, Wolfsohn AW, Lowman RM, Spiro HM. Effects of gastric intubation on normal mechanisms preventing gastroesophageal reflux. N Engl J Med. 1960; 262:1325–1328. PMID: 14425796.

10. Egan JV, Baron TH, Adler DG, Davila R, Faigel DO, Gan SL, et al. Esophageal dilation. Gastrointest Endosc. 2006; 63:755–760. PMID: 16650533.