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Anterograde–retrograde rendezvous approach for radiation-induced complete upper oesophageal sphincter stenosis: case report and literature review

Published online by Cambridge University Press:  19 May 2011

M P Kos ,
E F David  and
H F Mahieu
M P Kos*
Affiliation:
Department of Otolaryngology/Head and Neck Surgery, Free University Medical Center, Amsterdam, The Netherlands Department of Otolaryngology, Waterland Hospital, Purmerend, The Netherlands
E F David
Affiliation:
Department of Radiology, Free University Medical Center, Amsterdam, The Netherlands
H F Mahieu
Affiliation:
Department of Otolaryngology/Head and Neck Surgery, Meander Medical Center, Amersfoort, The Netherlands
*
Address for correspondence: Dr Martijn P Kos, Department of Otolaryngology, Waterland Hospital, PO Box 250, 1440 AG Purmerend, The Netherlands Fax: +31 299 457555 E-mail: [email protected]
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Abstract

Background:

Strictures of the hypopharynx and oesophagus are frequently observed following (chemo)radiation. Anterograde dilatation of a complete stenosis carries a high risk of perforation. An alternative is described: a combined anterograde–retrograde approach.

Case report:

A 75-year-old man developed complete stenosis of the oesophageal inlet after primary radiotherapy for laryngeal carcinoma and full percutaneous endoscopic gastrostomy feeding. To prevent creation of a false route into the mediastinum, a dilatation wire was introduced in a retrograde fashion into the oesophagus, through the gastrostomy opening. The wire was endoscopically identified from the proximal side and then passed through a perforation created by CO2 laser. Anterograde dilatation was safely performed, and the patient returned to a normal diet. There is consensus in the literature that blind anterograde dilatation carries a high risk of perforation; therefore, an anterograde–retrograde rendezvous technique is advisable.

Conclusion:

In cases of complete obstruction of the oesophageal inlet, anterograde–retrograde dilatation represents a safe technique with which to restore enteric continuity.

Keywords

DysphagiaConstriction, PathologicEndoscopic Surgical ProcedureHypopharynxOesophagusDilatation
Type
Clinical Records
Information
The Journal of Laryngology & Otology , Volume 125 , Issue 7 , July 2011 , pp. 761 - 764
Copyright
Copyright © JLO (1984) Limited 2011

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