Antegrade and retrograde endoscopic approach in the establishment of a neo-esophagus: a novel technique.
BACKGROUND
Although total obstruction or secondary atresia of the esophagus is extremely rare, high-grade strictures are not uncommon. The retrograde approach was previously described to achieve dilation when the conventional antegrade method fails.


METHODS
Gastroenterology laboratory in a tertiary referral center.


METHODS
A 30-year-old man with congenital T-cell immunodeficiency had complete esophageal obstruction after a severe episode of cryptococcal meningitis that required prolonged nasogastric intubation. For the next 3 years, he had daily episodes of regurgitations and several hospitalizations for aspiration pneumonia. A barium study revealed a dilated megaesophagus, with no contrast reaching to the stomach.


METHODS
Initially, a new track was created by using access from above and below the obstruction. This was followed by placement of a self-expandable silicone stent after allowing sufficient time for the new track to mature.


METHODS
Restoration of esophageal continuity, which allowed resolution of the patient's aspiration pneumonia and resumption of oral feeding.


CONCLUSIONS
Complete esophageal obstruction after prolonged nasogastric intubation is a rare but serious complication. A novel endoscopic approach can be used to restore esophageal continuity, minimize complications, and avoid major reconstructive surgeries.
Al-Haddad
Mohammad
M
Division of Gastroenterology and Hepatology, Mayo Clinic College of Medicine, Jacksonville, Florida 32224, USA. alhaddad.mohammad@mayo.edu
Pungpapong
Surakit
S
Wallace
Michael B
MB
Raimondo
Massimo
M
Woodward
Timothy A
TA
D000328:Adult; D004940:Esophageal Stenosis / Q000209:etiology / Q000628:therapy*; D004945:Esophagoscopy / Q000379:methods*; D005773:Gastroscopy / Q000379:methods*; D006801:Humans; D007441:Intubation, Gastrointestinal / Q000009:adverse effects; D008297:Male