Chances and challenges of combined antegrade and retrograde endoscopic recanalization of complete hypopharyngoesophageal obliteration: a case series
Background: Complete hypopharyngeal obliteration is a serious problem after radiochemotherapy. Data on rendezvous techniques using percutaneous retrograde endoscopy through the gastrostomy channel and antegrade laryngoscopy are limited with a possible bias on positive results.
Aim: This study aimed to review the clinical success, challenges, complications, and failure rates of this technique.
Methods: We prospectively collected data on endoscopic recanalization techniques, subsequent bougienages, adverse events, and final outcomes in seven patients.
Results: Recanalization was technically successful in all patients. However, normal food intake was achieved in only two patients, with one of them under ongoing bougienage. Additive treatment was needed in all patients, including microsurgical scar excision, temporary stent application, argon plasma coagulation, and surgical fistula closure. Salvage laryngopharyngectomy had to be performed in two of the seven patients. Preexisting hypopharyngo-tracheal fistula and therapy-induced fistula represent a technically demanding obstacle, necessitating endoscopic stenting and surgical closure.
Conclusion: Endoscopic recanalization of esophageal obliterations is feasible, although technically demanding. The clinical success rate for long-term normalization of oral food intake is, however, low. Prospective data collection in a larger cohort is urgently needed.
Relevance for Patients: Patients should be informed about the possibility of long-term follow-up treatments and the low clinical success rate of endoscopic recanalization by the rendezvous technique, as well as other alternative approaches while making the decision to accept the treatment.
[1] Ahlberg A, Al-Abany M, Alevronta E, Friesland S, Hellborg H, Mavroidis P, et al. Esophageal Stricture after Radiotherapy in Patients with Head and Neck Cancer: Experience of a Single Institution Over 2 Treatment Periods. Head Neck 2010;32:452-61. doi: 10.1002/hed.21201
[2] Laurell G, Kraepelien T, Mavroidis P, Lind BK, Fernberg JO, Beckman M, et al. Stricture of the Proximal Esophagus in Head and Neck Carcinoma Patients after Radiotherapy. Cancer 2003;97:1693-700. doi: 10.1002/cncr.11236
[3] Prisman E, Miles BA, Genden EM. Prevention and Management of Treatment-induced Pharyngo-oesophageal Stricture. Lancet Oncol 2013;14:e380-6. doi: 10.1016/S1470-2045(13)70160-8
[4] Francis DO, Hall E, Dang JH, Vlacich GR, Netterville JL, Vaezi MF. Outcomes of Serial Dilation for Highgrade Radiation-related Esophageal Strictures in Head and Neck Cancer Patients. Laryngoscope 2015;125:856-62. doi: 10.1002/lary.24987
[5] Goguen LA, Norris CM, Jaklitsch MT, Sullivan CA, Posner MR, Haddad RI, et al. Combined Antegrade and Retrograde Esophageal Dilation for Head and Neck Cancerrelated Complete Esophageal Stenosis. Laryngoscope 2010;120:261-6. doi: 10.1002/lary.20727
[6] Zhou JH, Jiang YG, Wang RW, Lin YD, Gong TQ, ZhaoYP, et al. Management of Corrosive Esophageal Burns in 149 Cases. J Thorac Cardiovasc Surg 2005;130:449-55. doi: 10.1016/j.jtcvs.2005.02.029
[7] Savvi SO, Korolevska AY, Bityak SY, Novikov YA. Complete Thoracic Esophagus Obliteration: Clinical Case Report. Wiad Lek 2021;74:155-60.
[8] Van Twisk JJ, Brummer RJ, Manni JJ. RetrogradeApproach to Pharyngo-esophageal Obstruction. Gastrointest Endosc 1998;48:296-9. doi: 10.1016/s0016-5107(98)70195-6
[9] O’Sullivan GC, O’Brien MG. Successful Retrograde Dilation and Oesophageal Conservation after Failed Antegrade Management of a Reflux Stricture. Endoscopy 1997;29:141. doi: 10.1055/s-2007-1004100
[10] Bueno R, Swanson SJ, Jaklitsch MT, Lukanich JM, Mentzer SJ, Sugarbaker DJ. Combined Antegrade and Retrograde Dilation: A New Endoscopic Technique in the Management of Complex Esophageal Obstruction. Gastrointest Endosc 2001;54:368-72. doi: 10.1067/mge.2001.117517
[11] Perbtani Y, Suarez AL, Wagh MS. Emerging Techniques and Efficacy of Endoscopic Esophageal Reconstruction and Lumen Restoration for Complete Esophageal Obstruction. Endosc Int Open 2016;4:E136-42. doi: 10.1055/s-0041-107898
[12] Steele NP, Tokayer A, Smith RV. Retrograde Endoscopic Balloon Dilation of Chemotherapy- and Radiation-induced Esophageal Stenosis Under Direct Visualization. Am J Otolaryngol 2007;28:98-102. doi: 10.1016/j.amjoto.2006.07.003
[13] Schembre D, Dever JB, Glenn M, Bayles S, Brandabur J, Kozarek R. Esophageal Reconstitution by Simultaneous Antegrade/Retrograde Endoscopy: Re-establishing Patency of the Completely Obstructed Esophagus. Endoscopy 2011;43:434-7. doi: 10.1055/s-0030-1256075
[14] Soares PC, Bouayed S, Dulguerov P, Frossarda JL. Recurrent Complete Pharyngo-Oesophageal Stricture Treated by Multidisciplinary Anterograde-Retrograde Endoscopic Dilation. Case Rep Gastroenterol 2016;10:560-7. doi: 10.1159/000450678
[15] Grooteman KV, Song LM, Vleggaar FP, Siersema PD, Baron TH. Functional Outcome of Patients Treated for Radiation-induced Complete Esophageal Obstruction after Successful Endoscopic Recanalization (with Video). Gastrointest Endosc 2014;80:175-81. doi: 10.1016/j.gie.2014.03.007
[16] Garcia A, Flores RM, Schattner M, Kraus D, Bains MS, Wong RJ, et al. Endoscopic Retrograde Dilation of Completely Occlusive Esophageal Strictures. Ann Thorac Surg 2006;82:1240-3. doi: 10.1016/j.athoracsur.2006.05.040
[17] Kawada H, Inaba Y, Yamaura H, Sato Y, Kato M, Kashima M, et al. Esophageal Stenting after Penetrating Complete Esophageal Obstruction Using a Trocar Stylet Via a Gastrostomy Route: A Case Report. Jpn J Radiol 2015;33:43-5. doi: 10.1007/s11604-014-0374-1
[18] Fusco S, Kratt T, Gani C, Stueker D, Zips D, Malek NP, et al. Rendezvous Endoscopic Recanalization for Complete Esophageal Obstruction. Surg Endosc 2018;32:4256-62. doi: 10.1007/s00464-018-6174-4
[19] Maple JT, Petersen BT, Baron TH, Kasperbauer JL, Song LM, Larson MV. Endoscopic Management of Radiation-induced Complete Upper Esophageal Obstruction with an Antegrade-retrograde Rendezvous Technique. Gastrointest Endosc 2006;64:822-8. doi: 10.1016/j.gie.2006.06.026
[20] Kohmura T, Hasegawa Y, Matsuura H, Terada A, Takahashi M, Nakashima T. Clinical Analysis of Multiple Primary Malignancies of the Hypopharynx and Esophagus. Am J Otolaryngol 2001;22:107-10. doi: 10.1053/ajot.2001.22566
[21] Vitali F, Nagel A, Pfeifer L, Goetz M, Siebler J, Neurath MF, et al. Endoscopic Recanalization of Complete Esophageal Obstruction. Surg Endosc 2021;35:3184-8. doi: 10.1007/s00464-021-08313-4
[22] Bertolini R, Meyenberger C, Putora PM, Albrecht F, Broglie MA, Stoeckli SJ, et al. Endoscopic Dilation of Complete Oesophageal Obstructions with a Combined Antegrade-Retrograde Rendezvous Technique. World J Gastroenterol 2016;22:2366-72. doi: 10.3748/wjg.v22.i7.2366
[23] Jayaraj M, Mohan BP, Mashiana H, Krishnamoorthi R, Adler DG. Safety and Efficacy of Combined Antegrade and Retrograde Endoscopic Dilation for Complete Esophageal Obstruction: A Systematic Review and Meta-analysis. Ann Gastroenterol 2019;32:361-9. doi: 10.20524/aog.2019.0385
[24] Coia LR, Myerson RJ, Tepper JE. Late Effects of Radiation Therapy on the Gastrointestinal Tract. Int J Radiat Oncol Biol Phys 1995;31:1213-36. doi: 10.1016/0360-3016(94)00419-L
[25] Gong EJ, Kim DH, Ahn JY, Choi KS, Jung KW, Lee JH, et al. Routine Endoscopic Screening for Synchronous Esophageal Neoplasm in Patients with Head and Neck Squamous Cell Carcinoma: A Prospective Study. Dis Esophagus 2016;29:752-9. doi: 10.1111/dote.12404
[26] Hoffmann J, Scheiderbauer H, Krimmel M, Grund KE, Reinert S. Value of Panendoscopic Examinations within the Scope of Diagnosing the Extent of Carcinoma of the Mouth Cavity. Mund Kiefer Gesichtschir 2002;6:111-6. doi: 10.1007/s10006-002-0366-7
[27] Wallach JB, Rosenstein MM, Kalnicki S. Localized Synchronous Squamous Cell Carcinomas of the Esophagus and Hypopharynx Treated with Definitive Concurrent Chemoradiotherapy with a Unified Radiotherapy Plan. Curr Oncol 2014;21:e354-7. doi: 10.3747/co.21.1844
[28] Felix C, Barreiro P, Azevedo JR, Maia L, KüttnerMagalhães R, Pedroto I, et al. Per-oral Endoscopic Tunneling for Restoration of the Esophagus (POETRE) in the Management of a Complete Esophageal Obstruction. Endosc Int Open 2021;9:E1084-5. doi: 10.1055/a-1463-3059
[29] Wagh MS, Draganov PV. Per-oral Endoscopic Tunneling for Restoration of the Esophagus: A Novel Endoscopic Submucosal Dissection Technique for Therapy of Complete Esophageal Obstruction. Gastrointest Endosc 2017;85:722-7. doi: 10.1016/j.gie.2016.08.035
[30] Wagh MS, Yang D, Chavalitdhamrong D, Draganov PV. Per-oral Endoscopic Tunneling for Restoration of the Esophagus (POETRE). Gastrointest Endosc 2014;80:330. doi: 10.1016/j.gie.2014.04.046