C0240 - Acute Esophageal Necrosis and Stricture Formation: A Case Report and Literature Review

Akshay Kapoor, MD, MSPH¹, Saad Saffo, MD², Kenneth W. Hung, MD, MS³, Darrick K. Li, MD, PhD^3
1Yale New Haven Hospital, New Haven, CT; ²Yale University/Yale-New Haven Hospital, New Haven, CT; ³Yale University School of Medicine, New Haven, CT

Introduction: Acute esophageal necrosis, or ‘black esophagus’, is an uncommon endoscopic finding characterized by dark discoloration of the esophageal mucosa that occurs in the context of ischemia, often in combination with other risk factors such as esophagitis, sepsis, or alcohol use. Although diagnostic and management considerations are well-described, limited data exist on frequency and risk factors for long-term complications, including stricture formation. We present a case of acute esophageal necrosis with stricture formation and provide a brief literature review relating to this complication.

Case Description/Methods: A 59-year-old man with history of alcohol use disorder, gastroesophageal reflux disease, and cardiovascular disease presented with epigastric pain and emesis and was found to be hypotensive. He was diagnosed with acute pancreatitis and managed conservatively with clinical improvement. During his hospitalization, he reported new-onset dysphagia and odynophagia. Barium esophagram demonstrated narrowing of the distal esophagus, and an endoscopy showed circumferential esophagitis with black eschar spanning the entire esophagus (Image 1A). He was started on a proton pump inhibitor and sucralfate. Endoscopy 8 weeks later revealed Los Angeles grade D esophagitis without bleeding and a lower esophageal stricture measuring 1 cm in diameter x 12 cm in length (Image 1B). In the context of severe esophagitis, dilation was deferred in favor of continued observation. The patient died 3 months later due to unrelated complications.

Methods: A literature review was conducted using the PubMed database for cases of acute esophageal necrosis and stricture. Risk factors, treatments, and outcomes associated with stricture formation were extracted from articles. Median, percentage, and counts were calculated for variables of interest.

Results: Out of 69 screened articles, 17 articles were included. Patients with strictures were older (median age 61.5 years), male (70%), or with shock or severe hypotension (80%) (Table 1). Perforation and death occurred in 10% of cases.

Discussion: Male sex, hypotension, older age are risk factors for stricture formation in the setting of acute esophageal necrosis. It is unclear if cardiac disease, diabetes, or alcohol/nonsteroidal anti-inflammatory drug use are associated with stricture formation. Perforation and death were rare complications. Further studies are needed, however, this analysis may help identify higher risk patients.




Disclosures:


Akshay Kapoor, MD, MSPH¹, Saad Saffo, MD², Kenneth W. Hung, MD, MS³, Darrick K. Li, MD, PhD³. C0240 - Acute Esophageal Necrosis and Stricture Formation: A Case Report and Literature Review, ACG 2022 Annual Scientific Meeting Abstracts. Charlotte, NC: American College of Gastroenterology.