Laparotomy enables retrograde dilatation and stent placement for malignant esophago-respiratory fistula.
BACKGROUND
Malignant esophageal stenosis with complete obstruction and esophagorespiratory fistula (ERF) is difficult to treat with standard endoscopic techniques.


METHODS
We report a patient in whom with local recurrence of esophageal carcinoma an esophagotracheal fistula occurred. Initially the patient had undergone esophageal resection with interposition of a gastric tube. Due to complete obstruction of the lumen by recurrent tumor conventional transoral stent placement failed. For retrograde dilatation a laparotomy was performed. Via a duodenal incision endoscopic access to the gastric tube was achieved. Using a guidewire the esophageal obstruction was traversed and dilated. Then it was possible to place an esophageal stent via an antegrade approach.


CONCLUSIONS
Open surgery enables a safe access for retrograde endoscopic therapy in patients who had undergone esophageal resection with gastric interposition.
Rehders
Alexander
A
Klinik für Allgemein-, Viszeral- und Kinderchirurgie, Heinrich Heine Universität, Düsseldorf, Germany. rehders@med.uni-duesseldorf.de
Cupisti
Kenko
K
Schmitt
Marcus
M
Renter
Marc A
MA
Kröpil
Patrick
P
Iskender
Ozcan
O
Knoefel
Wolfram T
WT
D000368:Aged; D004108:Dilatation, Pathologic; D004935:Esophageal Diseases / Q000000981:diagnostic imaging / Q000601:surgery* / Q000628:therapy; D006801:Humans; D007813:Laparotomy; D008297:Male; D011859:Radiography; D012141:Respiratory Tract Infections / Q000601:surgery* / Q000628:therapy; D015607:Stents; D014138:Tracheoesophageal Fistula / Q000601:surgery* / Q000628:therapy