title: Successful recovery of esophageal patency in 2 patients with complete obstruction by using combined antegrade retrograde dilation procedure, needle knife, and EUS needle.
abstract: BACKGROUND
  Esophageal occlusion is typically caused by cancer or postradiation changes; it is difficult to treat, with poor surgical outcomes. The combined antegrade retrograde dilation (CARD) method has been used to endoscopically restore the esophageal lumen after complete occlusion by cancer or postradiation changes, with good preliminary results. Reproducing this technique and improving its speed and convenience would be advances in treating this difficult clinical problem.
  
  
  OBJECTIVE
  A demonstration of 2 alternative endoscopic techniques for treating complete esophageal obstructions.
  
  
  METHODS
  The CARD method was performed in 2 patients with unresectable cancer and complete esophageal occlusion. In the first patient, a needle knife was used to cut through the obstruction, instead of removing it piecemeal with biopsy forceps before over-the-wire dilation. In the second patient, an EUS needle was used to cross a particularly long obstruction, which allowed subsequent dilation and recanalization.
  
  
  METHODS
  A tertiary referral center.
  
  
  METHODS
  Two patients with complete esophageal obstruction secondary to head and neck cancer, with associated radiation therapy.
  
  
  RESULTS
  In both cases, this method resulted in successful recanalization of the occluded lumen in a relatively short amount of time, without complications.
  
  
  CONCLUSIONS
  The small number of patients in this series.
  
  
  CONCLUSIONS
  The CARD needle-knife method may be a safe, effective, and efficient approach to complete esophageal occlusion. In addition, the CARD-EUS needle method may be an preferable technique to cross long obstructions quickly; however, more experience will be required.
authors.affiliation: Division of Gastroenterology and Hepatology, Pennsylvania State University Hospital, Hershey Medical Center, Hershey, Pennsylvania 17078, USA.
authors.forename: Matthew T
authors.initials: MT
authors.lastname: Moyer
authors.forename: Brendan C
authors.initials: BC
authors.lastname: Stack
authors.forename: Abraham
authors.initials: A
authors.lastname: Mathew
mesh_terms: D000368:Aged; D002294:Carcinoma, Squamous Cell / Q000150:complications; D002404:Catheterization / Q000295:instrumentation* / Q000379:methods*; D003131:Combined Modality Therapy; D016099:Endoscopy, Gastrointestinal / Q000379:methods; D019160:Endosonography / Q000295:instrumentation; D004938:Esophageal Neoplasms / Q000150:complications; D004940:Esophageal Stenosis / Q000209:etiology / Q000503:physiopathology* / Q000628:therapy*; D005260:Female; D005774:Gastrostomy; D006801:Humans; D008297:Male; D009339:Needles; D009959:Oropharyngeal Neoplasms / Q000150:complications; D018714:Radiotherapy, Adjuvant; D020127:Recovery of Function; D012107:Research Design; D016896:Treatment Outcome