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Antegrade and retrograde endoscopic approach in the establishment of a neo-esophagus: a novel technique.

Abstract：

BACKGROUND:Although total obstruction or secondary atresia of the esophagus is extremely rare, high-grade strictures are not uncommon. The retrograde approach was previously described to achieve dilation when the conventional antegrade method fails. SETTING:Gastroenterology laboratory in a tertiary referral center. PATIENT:A 30-year-old man with congenital T-cell immunodeficiency had complete esophageal obstruction after a severe episode of cryptococcal meningitis that required prolonged nasogastric intubation. For the next 3 years, he had daily episodes of regurgitations and several hospitalizations for aspiration pneumonia. A barium study revealed a dilated megaesophagus, with no contrast reaching to the stomach. INTERVENTION:Initially, a new track was created by using access from above and below the obstruction. This was followed by placement of a self-expandable silicone stent after allowing sufficient time for the new track to mature. MAIN OUTCOME MEASUREMENTS:Restoration of esophageal continuity, which allowed resolution of the patient's aspiration pneumonia and resumption of oral feeding. CONCLUSIONS:Complete esophageal obstruction after prolonged nasogastric intubation is a rare but serious complication. A novel endoscopic approach can be used to restore esophageal continuity, minimize complications, and avoid major reconstructive surgeries.

journal_name

Gastrointest Endosc

journal_title

Gastrointestinal endoscopy

authors

Al-Haddad M,Pungpapong S,Wallace MB,Raimondo M,Woodward TA

doi

10.1016/j.gie.2006.08.008

subject

Has Abstract

pub_date

2007-02-01 00:00:00

pages

290-4

issue

2

eissn

0016-5107

issn

1097-6779

pii

S0016-5107(06)02668-X

journal_volume

65

pub_type

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