279. ENDOSCOPIC RENDEZVOUS TECHNIQUE FOR RECANALIZATION OF COMPLETE ESOPHAGEAL OBLITERATION

Abstract

Abstract Background Radiation-induced esophageal stricture is a common late complication following radiation treatment for esophageal cancer or head and neck cancer. Currently, treatments for esophageal stricture are typically minimally invasive, as opposed to surgical reconstruction. However, this condition can significantly impact a patient’s quality of life during treatment including multiple sessions of dilatation, prolonged use of a nasogastric tube or gastrostomy status. In severe cases, complete esophageal obliteration can occur. The patients’ symptoms experienced are more severe than those in ordinary cases, marking endoscopic interventions more challenging and having a higher failure rate. This case report aims to demonstrate the use of the rendezvous technique in endoscopic treatment for the recanalization of the esophagus. Methods A 61-year-old female presented with dysphagia for two years. The patient had a history of hypopharyngeal cancer and underwent concurrent chemoradiation. During surveillance, the patient’s symptoms had worsened, and she was unable to eat or even swallow her own saliva. Endoscopic findings had shown complete esophageal obliteration, and a gastrostomy was performed. An endoscopic intervention was planned to use a two-team approach involving antegrade and retrograde endoscopy. The obstruction part was located at the upper thoracic esophagus using both endoscopes and esophagography. A retrograde guidewire was cannulated from the distal esophagus under fluoroscopic guidance. The guidewire position was checked from multidimensional fluoroscopic views to avoid false tract cannulation. Once the guidewire was nearly passed through the esophageal fibrotic septum, a stricturoplasty was performed from the antegrade endoscope. The guidewire was retrieved from the antegrade endoscope out of the oral cavity, and the esophagus was dilated with Savary-Gilliard dilators and a CRE balloon. A nasogastric tube was placed under direct endoscopic view. Results The procedure was successful, and the patency to the esophageal lumen was achieved. The patient’s symptoms improved, there was a decrease in saliva pooling. The patient was scheduled for serial dilatation of the esophagus to maintain luminal patency. Conclusion Endoscopic rendezvous technique is a safe therapeutic option for short-segment complete esophageal obliteration. Despite the complex procedure and multidisciplinary approach required, this technique can recanalize the esophageal lumen and avoid the need for surgical reconstruction.