Francesco Vitali1, Andreas Nägel1, Lukas Pfeifer1, Martin Goetz2, Jürgen Siebler1, Markus F Neurath1, Timo Rath3. 1. Division of Gastroenterology, Department of Internal Medicine I, Ludwig Demling Endoscopy Center of Excellence, Friedrich-Alexander-University Erlangen-Nuernberg, Ulmenweg 18, 91054, Erlangen, Germany. 2. Division of Gastroenterology and Oncology, Department of Internal Medicine IV, Klinikum Sindelfingen-Böblingen, Böblingen, Germany. 3. Division of Gastroenterology, Department of Internal Medicine I, Ludwig Demling Endoscopy Center of Excellence, Friedrich-Alexander-University Erlangen-Nuernberg, Ulmenweg 18, 91054, Erlangen, Germany. timo.rath@uk-erlangen.de.
Abstract
BACKGROUND AND AIMS: Complete esophageal obstruction (CEO) is a rare complication after radiochemotherapy that dramatically impairs quality of life. Within this study, we assessed the outcome of two different endoscopic techniques for lumen restoration in patients with CEO. METHODS: 17 patients were included. Esophageal recanalization was performed in an antegrade approach (Group A) or through combined antegrade and retrograde recanalization and dilatation (CARD, Group B). Technical success, complications, and dysphagia development during follow-up (FU) were compared between the groups. RESULTS: In Group A (n = 6), esophageal recanalization was performed by a single endoscopist with a median duration of 47 min. In two patients, antegrade recanalization led to formation of a false lumen (i.e., submucosal tunneling) followed by mediastinitis. In Group B, 21 CARD procedures were performed in 11 patients with a technical success rate of 100%. Procedure time was longer compared to Group A; however, no intra- or postprocedural complications were observed in Group B. CONCLUSIONS: In our experience and cohort, CARD was a successful procedure for recanalization of CEO, which exhibits a more favorable safety profile over antegrade recanalization. Further randomized studies to evaluate the treatment of CEO with CARD are needed.
BACKGROUND AND AIMS: Complete esophageal obstruction (CEO) is a rare complication after radiochemotherapy that dramatically impairs quality of life. Within this study, we assessed the outcome of two different endoscopic techniques for lumen restoration in patients with CEO. METHODS: 17 patients were included. Esophageal recanalization was performed in an antegrade approach (Group A) or through combined antegrade and retrograde recanalization and dilatation (CARD, Group B). Technical success, complications, and dysphagia development during follow-up (FU) were compared between the groups. RESULTS: In Group A (n = 6), esophageal recanalization was performed by a single endoscopist with a median duration of 47 min. In two patients, antegrade recanalization led to formation of a false lumen (i.e., submucosal tunneling) followed by mediastinitis. In Group B, 21 CARD procedures were performed in 11 patients with a technical success rate of 100%. Procedure time was longer compared to Group A; however, no intra- or postprocedural complications were observed in Group B. CONCLUSIONS: In our experience and cohort, CARD was a successful procedure for recanalization of CEO, which exhibits a more favorable safety profile over antegrade recanalization. Further randomized studies to evaluate the treatment of CEO with CARD are needed.