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154 Koschny et al. | Journal of Clinical and Translational Research 2024; 10(2): 151-158

A

B

C

Figure 1. Transgastric-retrograde rendezvous for recanalization of complete esophageal obstruction. (A) Normal gastroscope passage from the
oral side was blocked by a complete esophageal obstruction (left). Retrograde esophagoscopy via the percutaneous endoscopic gastrostomy (PEG)
channel showed complete obstruction from the gastric side (middle). Simultaneous ante- and retro-grade endoscopy via gastrostomy revealed a
20 mm esophageal occlusion (right, white arrows). (B) Periprocedural transillumination from the antegrade pharyngoscope was detected by retrograde
endoscopy via the PEG channel (left). The middle picture shows the per-oral puncture in rendezvous technique and the right picture shows the
insertion of a duodenal feeding tube after recanalization of the esophagus. (C) Repeated bougienages at the indicated time points led to a diameter of
up to 15 mm.

to follow-up in this palliative setting. Two patients needed salvage positive clinical results of the procedure might be overstated due
laryngopharyngectomy operations: One (#7) decided in favor of to a positive publication bias.
an operation after 12 dilatation sessions failed to bring clinical The reported median length of reopened obliterations was
improvement. Another patient (#4) developed a therapy-induced 23 mm with a wide range of 2 – 55 mm [18]. The reported primary
esophago-tracheal fistula (F - fistula, E - esophagus, Figure 4B) technical success rates for recanalization of complete obliterations
and failed to achieve therapeutic success after a long-term were high: 18/19 patients [18], 5/6 patients [22], 5/5 patients [13],
bouginage of 97 treatment sessions. 7/8 patients [19], and 11/11 patients (with 21 procedures) [21]. In
our series, all obliterations were successfully recanalized.
4. Discussion
There is a high variability in the used techniques and material
Recanalization of obliterated esophageal stenosis is a complex in our series as well as in published cases. For puncture of
multidisciplinary procedure and requires unconventional the obliterated tissue, endosonography needles have been
and individualized solutions to a multitude of problems and reported to be challenging due to their high flexibility [13], but
complications. Compared with combined ante- and retro-grade have been successfully applied by others [18]. We attempted
recanalization, antegrade endoscopic recanalization results in applying an ultrasound needle (19G, Olympus EZ Shot) in only
less complications but involves a longer intervention time [21]. one patient, but the tractability of the needle was too high for
Nevertheless, we are concerned that the previously reported successful puncture, possibly resulting in a pocket formation
DOI: https://doi.org/10.36922/jctr.23.00116