title: Endoscopic dilation of complete oesophageal obstructions with a combined antegrade-retrograde rendezvous technique.
abstract: OBJECTIVE
  To investigate the combined antegrade-retrograde endoscopic rendezvous technique for complete oesophageal obstruction and the swallowing outcome.
  
  
  METHODS
  This single-centre case series includes consecutive patients who were unable to swallow due to complete oesophageal obstruction and underwent combined antegrade-retrograde endoscopic dilation (CARD) within the last 10 years. The patients' demographic characteristics, clinical parameters, endoscopic therapy, adverse events, and outcomes were obtained retrospectively. Technical success was defined as effective restoration of oesophageal patency. Swallowing success was defined as either percutaneous endoscopic gastrostomy (PEG)-tube independency and/or relevant improvement of oral food intake, as assessed by the functional oral intake scale (FOIS) (≥ level 3).
  
  
  RESULTS
  The cohort consisted of six patients [five males; mean age 71 years (range, 54-74)]. All but one patient had undergone radiotherapy for head and neck or oesophageal cancer. Technical success was achieved in five out of six patients. After discharge, repeated dilations were performed in all five patients. During follow-up (median 27 mo, range, 2-115), three patients remained PEG-tube dependent. Three of four patients achieved relevant improvement of swallowing (two patients: FOIS 6, one patient: FOIS 7). One patient developed mediastinal emphysema following CARD, without a need for surgery.
  
  
  CONCLUSIONS
  The CARD technique is safe and a viable alternative to high-risk blind antegrade dilation in patients with complete proximal oesophageal obstruction. Although only half of the patients remained PEG-tube independent, the majority improved their ability to swallow.
authors.affiliation: Reto Bertolini, Christa Meyenberger, Franziska Albrecht, Michael Christian Sulz, Division of Gastroenterology and Hepatology, Kantonsspital St. Gallen, 9007 St. Gallen, Switzerland.
authors.forename: Reto
authors.initials: R
authors.lastname: Bertolini
authors.affiliation: Reto Bertolini, Christa Meyenberger, Franziska Albrecht, Michael Christian Sulz, Division of Gastroenterology and Hepatology, Kantonsspital St. Gallen, 9007 St. Gallen, Switzerland.
authors.forename: Christa
authors.initials: C
authors.lastname: Meyenberger
authors.affiliation: Reto Bertolini, Christa Meyenberger, Franziska Albrecht, Michael Christian Sulz, Division of Gastroenterology and Hepatology, Kantonsspital St. Gallen, 9007 St. Gallen, Switzerland.
authors.forename: Paul Martin
authors.initials: PM
authors.lastname: Putora
authors.affiliation: Reto Bertolini, Christa Meyenberger, Franziska Albrecht, Michael Christian Sulz, Division of Gastroenterology and Hepatology, Kantonsspital St. Gallen, 9007 St. Gallen, Switzerland.
authors.forename: Franziska
authors.initials: F
authors.lastname: Albrecht
authors.affiliation: Reto Bertolini, Christa Meyenberger, Franziska Albrecht, Michael Christian Sulz, Division of Gastroenterology and Hepatology, Kantonsspital St. Gallen, 9007 St. Gallen, Switzerland.
authors.forename: Martina Anja
authors.initials: MA
authors.lastname: Broglie
authors.affiliation: Reto Bertolini, Christa Meyenberger, Franziska Albrecht, Michael Christian Sulz, Division of Gastroenterology and Hepatology, Kantonsspital St. Gallen, 9007 St. Gallen, Switzerland.
authors.forename: Sandro J
authors.initials: SJ
authors.lastname: Stoeckli
authors.affiliation: Reto Bertolini, Christa Meyenberger, Franziska Albrecht, Michael Christian Sulz, Division of Gastroenterology and Hepatology, Kantonsspital St. Gallen, 9007 St. Gallen, Switzerland.
authors.forename: Michael Christian
authors.initials: MC
authors.lastname: Sulz
mesh_terms: D000368:Aged; D003679:Deglutition; D004106:Dilatation; D004435:Eating; D004940:Esophageal Stenosis / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000628:therapy*; D004945:Esophagoscopy / Q000379:methods*; D004947:Esophagus / Q000000981:diagnostic imaging / Q000503:physiopathology*; D005260:Female; D005774:Gastrostomy / Q000295:instrumentation; D006801:Humans; D008297:Male; D008875:Middle Aged; D020127:Recovery of Function; D019233:Retreatment; D012189:Retrospective Studies; D013557:Switzerland; D013997:Time Factors; D016896:Treatment Outcome
keywords: Combined antegrade-retrograde endoscopic dilation; Endoscopic dilation; Head and neck cancer; Oesophageal obstruction; Radiotherapy; Rendezvous technique