title: Laparotomy enables retrograde dilatation and stent placement for malignant esophago-respiratory fistula.
abstract: 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.
authors.affiliation: Klinik für Allgemein-, Viszeral- und Kinderchirurgie, Heinrich Heine Universität, Düsseldorf, Germany. rehders@med.uni-duesseldorf.de
authors.forename: Alexander
authors.initials: A
authors.lastname: Rehders
authors.forename: Kenko
authors.initials: K
authors.lastname: Cupisti
authors.forename: Marcus
authors.initials: M
authors.lastname: Schmitt
authors.forename: Marc A
authors.initials: MA
authors.lastname: Renter
authors.forename: Patrick
authors.initials: P
authors.lastname: Kröpil
authors.forename: Ozcan
authors.initials: O
authors.lastname: Iskender
authors.forename: Wolfram T
authors.initials: WT
authors.lastname: Knoefel
mesh_terms: 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