Combined Endoscopic Techniques for Esophageal Pinhole-like Stenosis after Photodynamic Therapy

Photodynamic therapy (PDT) is gaining attention as a salvage therapy for recurrent esophageal cancer after chemoradiotherapy (CRT). The incidence of post-PDT scar stenosis, one of the associated adverse events, is relatively high. It occurs in about 30% of the patients in our hospital and requires attention because it significantly reduces the patient’s quality of life. In most cases, endoscopic balloon dilatation (EBD) is successful in improving stenosis. However, refractory or severe stenosis is possible in patients undergoing extensive laser irradiation or multiple PDT for recurrent esophageal cancer, and the endoscopic balloon dilation alone may not be sufficient to sustain the opening of the stenosis. Radial incision and cutting (RIC) have been proposed as a new stenosis-reversal technique for such cases. RIC is highly satisfactory for patients because it reliably removes scar tissue and dramatically improves the passage. However, the restenosis rate after RIC is high, and the need for repeated prophylactic balloon dilatations and steroid administration has been reported. In this case report, we describe a case of pinhole-like stenosis that was difficult to treat with balloon dilation or RIC alone. In these cases, we also report the effective treatment approach implemented with a combination of incision using a needle knife, EBD, and RIC. this treatment resulted in a good improvement in quality of life.