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

  • M P Kos (a1) (a2), E F David (a3) and H F Mahieu (a4)
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.

Copyright
Corresponding author
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: martijn.kos@gmail.com
References
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The Journal of Laryngology & Otology
  • ISSN: 0022-2151
  • EISSN: 1748-5460
  • URL: /core/journals/journal-of-laryngology-and-otology
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