Combined antegrade and retrograde dilation: a new endoscopic technique in the management of complex esophageal obstruction.
BACKGROUND
Esophageal strictures that cause complete obstruction are often difficult to dilate with standard bougienage techniques.


METHODS
A new technique was developed and applied, combined antegrade and retrograde dilation, for dilatation of complex esophageal strictures. The stomach is accessed and an endoscope (9.8 mm diameter) is directed under fluoroscopy in a retrograde fashion into the distal esophagus. A guidewire with a hydrophilic coating is advanced through the stricture and then pulled through the mouth with a simultaneously placed proximal endoscope. The guidewire is then used as a guide for antegrade esophageal dilatation.


RESULTS
Ten patients with complex esophageal strictures (with and without fistulas) were treated with this technique. Three required a second combined antegrade and retrograde dilation procedure. All strictures were dilated and no perforations occurred.


CONCLUSIONS
Combined antegrade and retrograde dilation is a safe and effective technique for dilation of complex obstructing esophageal lesions.
Bueno
R
R
Division of Thoracic Surgery, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts 02115, USA.
Swanson
S J
SJ
Jaklitsch
M T
MT
Lukanich
J M
JM
Mentzer
S J
SJ
Sugarbaker
D J
DJ
D000368:Aged; D000369:Aged, 80 and over; D019072:Antibiotic Prophylaxis; D004106:Dilatation / Q000379:methods; D004724:Endoscopy / Q000379:methods*; D004937:Esophageal Fistula / Q000150:complications; D004940:Esophageal Stenosis / Q000209:etiology / Q000628:therapy*; D005260:Female; D005471:Fluoroscopy; D005774:Gastrostomy; D006801:Humans; D007582:Jejunostomy; D008297:Male; D008875:Middle Aged