Reply to Mavrogenis et al.

We appreciate the comments of Dr Mavrogenis and colleagues regarding the use of transillumination during rendezvous endoscopy for stenotic or obliterated esophageal lumens. We agree that this is a useful technique when trying to localize an endoscope in a closely adjacent lumen. We attempted transillumination in all of our cases of esophageal obstruction, but in three cases we were unable to visualize or at least localize the light from the adjacent endoscope. This may have been a result of the dense tissues and poor pliability of the irradiated tissues in the proximal esophagus but more likely was simply a function of the distance between the two lumens. We have had greater success with transillumination when by-passing colonic obstructions with a de-novo colorectal puncture and anastomosis, where the relatively thin colon walls can be manipulated and closely approximated. Endoscopic ultrasound (EUS) has been proposed as another technique for creating transluminal anastomoses [1], but even an end-viewing EUS device would be difficult to utilize in the obstructed esophagus. One wonders if a narrow, intense, red-spectrum light might provide better localization in thicker, denser tissues.

As gastroenterologists, we are used to looking for light in dark places and find it gratifying when we can find it.

References

• 1 Bergström M, Ikeda K, Swain P, Park P. Transgastric anastomosis by using flexible endoscopy in a porcine model.  Gastrointest Endosc. 2006;  63 307-312