Endoscopic retrograde dilation of completely occlusive esophageal strictures.
BACKGROUND
Completely occlusive esophageal strictures may develop after head and neck radiotherapy or esophagectomy with gastric or colonic interposition. Major surgical intervention may be required to restore alimentary tract patency when endoscopic lumen reconstitution is not feasible by routine antegrade endoscopy. Retrograde endoscopic lumen identification and dilation is a useful method to reestablish alimentary tract patency, thereby avoiding surgical intervention.


METHODS
Patients requiring endoscopic dilation for completely occlusive esophageal strictures were identified by the gastroenterology, thoracic, and head and neck services. Retrograde access was obtained by balloon dilation of either a jejunostomy or gastrostomy tract, and an endoscope was passed to the area of stricture. Antegrade and retrograde endoscopy were performed simultaneously. A guidewire was passed either retrograde or antegrade under direct endoscopic visualization, followed by antegrade Savary dilation under fluoroscopic guidance.


RESULTS
From 2003 to 2006, 9 patients were identified with completely occlusive esophageal strictures requiring retrograde lumen identification and dilation. Stricture developed in 6 patients after radiotherapy for head and neck cancer and in 3 after esophagectomy with either gastric or colonic interposition for esophageal cancer. Endoscopic dilation was successful in all patients, without perforation.


CONCLUSIONS
Retrograde endoscopic lumen identification and dilation is an option to reestablish lumen patency of completely occlusive esophageal strictures after esophagectomy with gastric or colonic interposition or after head and neck chemoradiotherapy.
Garcia
Alejandro
A
Division of Thoracic Surgery, Memorial Sloan-Kettering Cancer Center, New York, New York 10021, USA.
Flores
Raja M
RM
Schattner
Mark
M
Kraus
Dennis
D
Bains
Manjit S
MS
Wong
Richard J
RJ
Rizk
Nabil
N
Markowitz
Arnold
A
Gerdes
Hans
H
Shike
Moshe
M
D000368:Aged; D000369:Aged, 80 and over; D002404:Catheterization / Q000379:methods*; D004938:Esophageal Neoplasms / Q000601:surgery; D004940:Esophageal Stenosis / Q000209:etiology / Q000628:therapy*; D016629:Esophagectomy / Q000009:adverse effects; D004945:Esophagoscopy; D005260:Female; D006258:Head and Neck Neoplasms / Q000532:radiotherapy; D006801:Humans; D008297:Male; D010030:Ostomy; D011878:Radiotherapy / Q000009:adverse effects