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Endoscopy in Microstomia: Thinking Outside the Box
Raja Shekhar R. Sappati-Biyyani, Annette Kyprianou, D. Roy Ferguson
A 43-year-old woman with a history of systemic sclerosis, GERD, hypertension and hyperlipidemia was admitted to the hospital with complaints of nausea, bilious vomiting and abdominal pain. Scleroderma was diagnosed in 2006 when she was admitted with worsening shortness of breath and hypertensive crises along with renal failure. The patient developed skin tightening, sclerodactyly, esophageal dysmotility, calcinosis, Raynaud phenomenon and telangiectasis. The patient was referred to undergo esophagogastroduodenoscopy for further evaluation.
On physical examination, the patient had poor oral hygiene, but had a complete set of teeth. However, the intercommissural distance, the interincisal distance and the maximum oral aperture were all reduced severely. Microstomia restricted insertion of both adult and pediatric bite blocks for the procedure. We successfully completed the procedure using a bite block made of a 10-mL plastic syringe (figure).
Read more in Clinical Gastroenterology and Hepatology.
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