Klinkert M, de Jong MC, Sosef MN, van Nunen AB, Belgers HJ. Surgical treatment of a rare complication after endoscopic stent placement for anastomotic leakage after esophageal resection. World J Surg Proced 2017; 7(1): 1-5 [DOI: 10.5412/wjsp.v7.i1.1]
Corresponding Author of This Article
Marjan Klinkert, MD, Department of Surgery, Zuyderland Medical Centre, Henri Dunantstraat 5, 6419 PC Heerlen, The Netherlands. m.klinkert@zuyderland.nl
Research Domain of This Article
Surgery
Article-Type of This Article
Case Report
Open-Access Policy of This Article
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/
World J Surg Proced. Mar 28, 2017; 7(1): 1-5 Published online Mar 28, 2017. doi: 10.5412/wjsp.v7.i1.1
Surgical treatment of a rare complication after endoscopic stent placement for anastomotic leakage after esophageal resection
Marjan Klinkert, Mechteld C de Jong, Meindert N Sosef, Annick B van Nunen, Henricus J Belgers
Marjan Klinkert, Mechteld C de Jong, Meindert N Sosef, Henricus J Belgers, Department of Surgery, Zuyderland Medical Centre, 6419 PC Heerlen, The Netherlands
Annick B van Nunen, Department of Gastroenterology, Zuyderland Medical Centre, 6419 PC Heerlen, The Netherlands
Author contributions: Klinkert M and de Jong MC designed and wrote the paper; Sosef MN, van Nunen AB and Belgers HJ designed- and performed the procedure.
Institutional review board statement: This case report was reviewed by our local IRB and according to local guidelines no official review was necessary.
Informed consent statement: The patient involved in this study gave her written informed consent authorizing use and disclosure of her protected health information.
Conflict-of-interest statement: None of the above participants declare to have conflict-of-interests.
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: Marjan Klinkert, MD, Department of Surgery, Zuyderland Medical Centre, Henri Dunantstraat 5, 6419 PC Heerlen, The Netherlands. m.klinkert@zuyderland.nl
Telephone: +31-455-766666 Fax: +31-455-767625
Received: February 3, 2017 Peer-review started: February 7, 2017 First decision: March 7, 2017 Revised: March 15, 2017 Accepted: March 20, 2017 Article in press: March 21, 2017 Published online: March 28, 2017 Processing time: 72 Days and 12.8 Hours
Abstract
The best approach to achieve cure in esophageal cancer is a combination of chemo-radiation and surgery. However, complications occur in half of patients. The current report, reports a rare but severe complication: Complete obstruction of the esophagus, induced by preoperative chemo-radiation therapy. Normally, strictures are treated by repeated dilatations, however, in case of complete obstruction, the perforation rate of standard blind anterograde wire access and dilation is severely increased. In order to minimize the risk of perforations, the rendezvous technique was introduced. This technique involves an anterograde approach in combination with a retrograde approach in order to open and dilatate the esophagus. While technical success rates between 83% and 100% have been reported in literature, data on clinical outcomes are scarcer. The limited amount of studies available claim that success was achieved in almost half of patients. The patient in our case currently has an oral diet without restrictions and rates his quality of life with a VAS-score ten out of ten.
Core tip: A rare but severe complication of chemo-radiation of the esophagus, in case of esophageal cancer, is a complete esophageal obstruction. Blind anterograde wire access and dilatation leads to a higher risk of perforation, due to lack of visualization and a disrupted anatomy. For this reason the rendezvous technique was introduced, which involves an anterograde approach in combination with a retrograde approach in order to open and dilatate the esophagus.
