Endoscopic removal of obstructing sutures using argon plasma coagulation

We present two unusual cases of persistent dysphagia, months after Ivor Lewis esophagectomy for esophageal adenocarcinoma, caused by retained sutures and staples blocking the passageway of food and fluid through the esophagus. We demonstrate the use of argon plasma coagulation (APC) at 30-W forced coagulation at 1 L/min to completely remove the PDS sutures from the esophagus with minimal damage to the underlying mucosa. We use the smaller diameter 4.5 fr catheter for precise APC application, using small bursts to melt the suture and staples. This method is safe and effective and can be performed by any endoscopist trained to use APC. After removing the obstructing sutures, we proceeded with balloon dilation of the narrowed anastomosis. Suture removal with APC treatment and subsequent stricture dilation led to significant improvement in symptoms and quality of life.