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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)

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.


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

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:
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1de Boer, MF, Pruyn, JF, van den Borne, B, Knegt, PP, Ryckman, RM, Verwoerd, CD. Rehabilitation outcomes of long-term survivors treated for head and neck cancer. Head Neck 1995;17:503–15
2Laurell, G, Kraepelien, T, Mavroidis, P, Lind, BK, Fernberg, JO, Beckman, M et al. Stricture of the proximal esophagus in head and neck carcinoma patients after radiotherapy. Cancer 2003;97:1693–700
3Lawson, JD, Otto, K, Grist, W, Johnstone, PA. Frequency of esophageal stenosis after simultaneous modulated accelerated radiation therapy and chemotherapy for head and neck cancer. Am J Otolaryngol 2008;29:1319
4Guadagnolo, BA, Haddad, RI, Posner, MR, Weeks, L, Wirth, LJ, Norris, CM et al. Organ preservation and treatment toxicity with induction chemotherapy followed by radiation therapy or chemoradiation for advanced laryngeal cancer. Am J Clin Oncol 2005;28:371–8
5Piotet, E, Escher, A, Monnier, P. Esophageal and pharyngeal strictures: report on 1,862 endoscopic dilatations using the Savary-Gilliard technique. Eur Arch Otorhinolaryngol 2008;265:357–64
6van Twisk, JJ, Brummer, RJ, Manni, JJ. Retrograde approach to pharyngo-esophageal obstruction. Gastrointest Endosc 1998;48:296–9
7Nguyen, NP, Sallah, S, Karlsson, U, Antoine, JE. Combined chemotherapy and radiation therapy for head and neck malignancies: quality of life issues. Cancer 2002;94:1131–41
8Silvain, C, Barrioz, T, Besson, I, Babin, P, Fontanel, JP, Daban, A, Matuchansky, C, Beauchant, M. Treatment and long-term outcome of chronic radiation esophagitis after radiation therapy for head and neck tumors. A report of 13 cases. Dig Dis Sci 1993;38:927–31
9Lee, WT, Akst, LM, Adelstein, DJ, Saxton, JP, Wood, BG, Strome, M et al. Risk factors for hypopharyngeal/upper esophageal stricture formation after concurrent chemoradiation. Head Neck 2006;28:808–12
10Mekhail, TM, Adelstein, DJ, Rybicki, LA, Larto, MA, Saxton, JP, Lavertu, P. Enteral nutrition during the treatment of head and neck carcinoma: is a percutaneous endoscopic gastrostomy tube preferable to a nasogastric tube? Cancer 2001;91:1785–90
11Eisbruch, A, Lyden, T, Bradford, CR, Dawson, LA, Haxer, MJ, Miller, AE et al. Objective assessment of swallowing dysfunction and aspiration after radiation concurrent with chemotherapy for head-and-neck cancer. Int J Radiat Oncol Biol Phys 2002;53:23–8
12Petro, M, Wein, RO, Minocha, A. Treatment of a radiation-induced esophageal web with retrograde esophagoscopy and puncture. Am J Otolaryngol 2005;26:353–5
13Maple, JT, Petersen, BT, Baron, TH, Kasperbauer, JL, Wong Kee Song, LM, Larson, MV. Endoscopic management of radiation-induced complete upper esophageal obstruction with an antegrade-retrograde rendezvous technique. Gastrointest Endosc 2006;64:822–8
14Oxford, LE, Ducic, Y. Retrograde balloon dilation of complete cervical esophageal and hypopharyngeal strictures. J Otolaryngol 2006;35:327–31
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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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