Chances and challenges of combined antegrade and retrograde endoscopic recanalization of complete hypopharyngoesophageal obliteration: a case series

Abstract

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.