Endoscopic therapy for upper gastrointestinal bleeding: less is more?

An elderly patient with a known symptomatic oesophageal radiation stricture had endoscopic dilatation to 15 mm to good effect. The stricture developed as a consequence of radical chemoradiotherapy for unresectable lung cancer more than 7 years ago. Repeat biopsies did not reveal dysplasia or malignancy. Four months later, a CT was performed as part of lung cancer follow-up. It did not show evidence of cancer recurrence; however, a small asymptomatic mid-oesophageal perforation was identified. This was managed conservatively by nasojejunal feeding. Repeat CT with oral contrast showed no evidence of contrast extravasation. After multidisciplinary discussion, fibrin sealant …