title: Anterograde-retrograde rendezvous approach for radiation-induced complete upper oesophageal sphincter stenosis: case report and literature review.
abstract: BACKGROUND
  Strictures of the hypopharynx and oesophagus are frequently observed following (chemo)radiation. Anterograde dilatation of a complete stenosis carries a high risk of perforation. An alternative is described: a combined anterograde-retrograde approach.
  
  
  METHODS
  A 75-year-old man developed complete stenosis of the oesophageal inlet after primary radiotherapy for laryngeal carcinoma and full percutaneous endoscopic gastrostomy feeding. To prevent creation of a false route into the mediastinum, a dilatation wire was introduced in a retrograde fashion into the oesophagus, through the gastrostomy opening. The wire was endoscopically identified from the proximal side and then passed through a perforation created by CO2 laser. Anterograde dilatation was safely performed, and the patient returned to a normal diet. There is consensus in the literature that blind anterograde dilatation carries a high risk of perforation; therefore, an anterograde-retrograde rendezvous technique is advisable.
  
  
  CONCLUSIONS
  In cases of complete obstruction of the oesophageal inlet, anterograde-retrograde dilatation represents a safe technique with which to restore enteric continuity.
authors.affiliation: Department of Otolaryngology/Head and Neck Surgery, Free University Medical Center, Amsterdam, The Netherlands. martijn.kos@gmail.com
authors.forename: M P
authors.initials: MP
authors.lastname: Kos
authors.forename: E F
authors.initials: EF
authors.lastname: David
authors.forename: H F
authors.initials: HF
authors.lastname: Mahieu
mesh_terms: D000368:Aged; D002277:Carcinoma / Q000532:radiotherapy; D004106:Dilatation / Q000295:instrumentation / Q000379:methods*; D049631:Esophageal Sphincter, Upper / Q000528:radiation effects*; D004940:Esophageal Stenosis / Q000209:etiology / Q000601:surgery*; D006801:Humans; D007013:Hypopharynx; D007441:Intubation, Gastrointestinal / Q000295:instrumentation; D007822:Laryngeal Neoplasms / Q000532:radiotherapy; D053685:Laser Therapy; D008297:Male; D011832:Radiation Injuries / Q000150:complications / Q000601:surgery*; D012086:Reoperation; D016896:Treatment Outcome