Endoscopy 2020; 52(S 01): S54
DOI: 10.1055/s-0040-1704166
ESGE Days 2020 oral presentations
Thursday, April 23, 2020 16:30 – 18:00 Stent, seal, stitch. Advanced upper GI Ecocem Room therapeutics
© Georg Thieme Verlag KG Stuttgart · New York

ENDOSCOPIC TREAMTMENT OF COMPLETE ESOPHAGEAL OBSTRUCTION: A COMPARISON BETWEEN TWO DIFFERENT APPROACHES

T Rath
1   University Hospital Erlangen, Department of Gastroenterology, Ludwig Demling Endoscopy Center of Excellence, Erlangen, Germany
,
F Vitali
1   University Hospital Erlangen, Department of Gastroenterology, Ludwig Demling Endoscopy Center of Excellence, Erlangen, Germany
,
A Nägel
1   University Hospital Erlangen, Department of Gastroenterology, Ludwig Demling Endoscopy Center of Excellence, Erlangen, Germany
,
J Siebler
1   University Hospital Erlangen, Department of Gastroenterology, Ludwig Demling Endoscopy Center of Excellence, Erlangen, Germany
,
MF Neurath
1   University Hospital Erlangen, Department of Gastroenterology, Ludwig Demling Endoscopy Center of Excellence, Erlangen, Germany
› Author Affiliations
Further Information

Publication History

Publication Date:
23 April 2020 (online)

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Aims The development of esophageal stricture is frequently observed after radiochemoherapy (RCT). At the same time, with an incidence < 1%, complete esophageal obstruction is a rare complication of RCT. Nevertheless, complete obstruction is associated with significant impairment in the quality of life and renders patients susceptible for the development of secondary conditions such as aspiration pneumonia. Within this study,compared the outcome of two different techniques for lumen restoration of a completely obstructed esophagus.

Methods Technical success, complication rate and development of dysphagia during follow-up were compared in patients with aphagia and documented complete esophageal obstruction that were treated with either antegrade recanalization during EGD (Group A) or combined antegrade - retrograde recanalization perorally and through gastrostomy by endoscopic rendezvous (Group B).

Results A total of 14 patients (mean age 67.8 years) with complete esophageal obstruction were included. In Group A (n=6, antegrade approach), esophageal recanalization was performed by a single endoscopist with a mean procedure duration of 67 minutes. In two of the six patients, solely antegrade recanalization led to unintended formation of a false lumen (i.e. submucosal tunneling) followed by mediastinitis which resolved under conservative treatment. In group B (n=8, combined antegrade-retrograde rendezvous procedure) median procedure time to achieve esophageal recanalization was longer (mean duration 87 minutes) compared to group A; however, no intra- or postprocedural complications were observed. Median follow-up (FU) was 25 (Group A) and 26 months (Group B). Due to incompliance, five patients of group B, did not follow a regular bouginage protocol after restoration of esophageal patency, leading to re-occurrence of complete esophageal obstruction during FU. Importantly, all these re-occurred complete obstructions were successfully re-canalized with antegrade-retrograde endoscopic rendezvous.

Conclusions Rendezvous recanalization is a reliable and safe method to re-establish luminal patency and should be the preferred method for the treatment of complete esophageal obstruction