Page 57 - JCTR-10-2

Journal of Clinical and Translational Research 2024; 10(2): 151-158

Journal of Clinical and Translational Research

Journal homepage: http://www.jctres.com/en/home

ORIGINAL ARTICLE

Chances and challenges of combined antegrade and retrograde

endoscopic recanalization of complete hypopharyngoesophageal
obliteration: a case series

Ronald Koschny *, Philippe Federspil , Peter Sauer , Christian Brunner , Peter K. Plinkert , Gerhard Dyckhoff 2
1
1
3
2
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1 Interdisciplinary Endoscopy Center (IEZ), Department of Gastroenterology, University Hospital Heidelberg, Heidelberg, Germany, Department of
Otorhinolaryngology, Head and Neck Surgery, University Hospital Heidelberg, Heidelberg, Germany, Department of Radiology, University Hospital
3
Heidelberg, Heidelberg, Germany
ARTICLE INFO Abstract
Article history: Background: Complete hypopharyngeal obliteration is a serious problem after radiochemotherapy.
Received: 02 October, 2023 Data on rendezvous techniques using percutaneous retrograde endoscopy through the gastrostomy
Accepted: 26 October, 2023 channel and antegrade laryngoscopy are limited with a possible bias on positive results.
Published Online: March 28, 2024 Aim: This study aimed to review the clinical success, challenges, complications, and failure rates of
this technique.
Keywords: Methods: We prospectively collected data on endoscopic recanalization techniques, subsequent
Hypopharynx obstruction bougienages, adverse events, and final outcomes in seven patients.
Rendezvous endoscopic recanalization Results: Recanalization was technically successful in all patients. However, normal food intake
Gastrostomy was achieved in only two patients, with one of them under ongoing bougienage. Additive treatment
Oropharyngeal carcinoma was needed in all patients, including microsurgical scar excision, temporary stent application, argon
Deglutition plasma coagulation, and surgical fistula closure. Salvage laryngopharyngectomy had to be performed
Deglutition disorder 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.
*Corresponding authors: Conclusion: Endoscopic recanalization of esophageal obliterations is feasible, although technically
Ronald Koschny demanding. The clinical success rate for long-term normalization of oral food intake is, however, low.
Interdisciplinary Endoscopy Center (IEZ), Prospective data collection in a larger cohort is urgently needed.
Department of Gastroenterology, University Relevance for Patients: Patients should be informed about the possibility of long-term follow-up
Hospital Heidelberg, Heidelberg, Germany. treatments and the low clinical success rate of endoscopic recanalization by the rendezvous technique,
Email: Ronald.Koschny@med.uni-heidelberg.de as well as other alternative approaches while making the decision to accept the treatment.
© 2024 Author(s). This is an Open-Access
article distributed under the terms of the
Creative Commons Attribution-Noncommercial 1. Introduction
License, permitting all non-commercial use,
distribution, and reproduction in any medium, Hypopharyngoesophageal strictures occur in approximately 3% of patients after
provided the original work is properly cited. radiotherapy for head and neck cancers, squamous cell carcinomas of the upper esophagus,
and laryngeal or oropharyngeal cancers [1,2]. A radiation dose >45 – 60 Gy is a risk
factor for stricture formation [1,3]. Complete esophageal obliteration has been reported in
23 – 50% of preselected patients with radiation-induced esophageal strictures [2,4]. The
most common site for radiation-induced stenosis is the post-cricoid or cricopharyngeal
region [5]. In contrast to subtotal esophageal stenosis, which can be easily treated by
endoscopic bougienage, complete obstruction of the lumen usually requires alternative
approaches, such as surgical revision, which is a complex and difficult procedure in the
pretreated proximal esophagus [3,6].

DOI: https://doi.org/10.36922/jctr.23.00116