Observational Study
Copyright ©The Author(s) 2016. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Feb 21, 2016; 22(7): 2366-2372
Published online Feb 21, 2016. doi: 10.3748/wjg.v22.i7.2366
Endoscopic dilation of complete oesophageal obstructions with a combined antegrade-retrograde rendezvous technique
Reto Bertolini, Christa Meyenberger, Paul Martin Putora, Franziska Albrecht, Martina Anja Broglie, Sandro J Stoeckli, Michael Christian Sulz
Reto Bertolini, Christa Meyenberger, Franziska Albrecht, Michael Christian Sulz, Division of Gastroenterology and Hepatology, Kantonsspital St. Gallen, 9007 St. Gallen, Switzerland
Paul Martin Putora, Department of Radiation Oncology, Kantonsspital St. Gallen, 9007 St. Gallen, Switzerland
Martina Anja Broglie, Sandro J Stoeckli, Department of Otorhinolaryngology, Head and Neck Surgery, Kantonsspital St. Gallen, 9007 St. Gallen, Switzerland
Author contributions: Sulz MC designed the study together with Bertolini R; all authors provided data; Sulz MC, Bertolini R, Putora PM, Albrecht F and Broglie MA analysed and interpreted the data and wrote the manuscript; Meyenberger C and Stoeckli SJ interpreted the data and revised the manuscript; all authors approved the final version of the manuscript.
Institutional review board statement: The study was reviewed and approved by the Institutional Review Board of the Cantonal Hospital St. Gallen.
Informed consent statement: All study participants, or their legal guardian, provided informed written consent prior to study enrolment.
Conflict-of-interest statement: All authors disclosed no financial relationships relevant to this publication.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Michael Christian Sulz, MD, Division of Gastroenterology and Hepatology, Kantonsspital St. Gallen, 9007 St. Gallen, Switzerland. michael.sulz@kssg.ch
Telephone: +41-71-4941245 Fax: +41-71-4946327
Received: September 17, 2015
Peer-review started: September 17, 2015
First decision: October 14, 2015
Revised: November 3, 2015
Accepted: December 8, 2015
Article in press: December 8, 2015
Published online: February 21, 2016
Processing time: 136 Days and 1.7 Hours
Abstract

AIM: 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.

CONCLUSION: 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.

Keywords: Oesophageal obstruction; Rendezvous technique; Combined antegrade-retrograde endoscopic dilation; Endoscopic dilation; Head and neck cancer; Radiotherapy

Core tip: Complete obstruction in the proximal oesophagus is rare after radiotherapy for head and neck cancers. We present our institutional experience with endoscopic rendezvous dilation and the clinical outcomes. This technique offers a safe and viable alternative to high-risk blind antegrade dilation. In our series, the rate of technical success was high. Although half of the patients remained percutaneous endoscopic gastrostomy-tube dependent, the majority showed relevant improvement in their ability to swallow and, consequently, in their quality of life.