Transgastric Esophagoscopy with Antegrade Dilation

Abstract

An 80-year-old man in whom successful dilation of an obstructed esophagus via retrograde esophagoscopy was carried out is reported here. His nutrition had been previously sustained by a feeding gastrostomy tube inserted under radiologic guidance. This gastrostomy stoma was dilated to allow passage of a pediatric gastroscope into the stomach and esophagus. A guide wire was then negotiated past the esophageal stricture, under endoscopic vision and fluoroscopic guidance, into the oropharynx. Savary dilators were then passed over the guide wire perorally to dilate the stenosis. The patient was able to swallow liquids soon after the procedure. The use of Savary dilators over a guide wire introduced by retrograde esophagoscopy has not been previously described.

Endoscopic Management of Hypopharyngeal Stenosis after Organ Sparing Therapy for Head and Neck Cancer

“…The concept of TREAD is not new and has been reported for the treatment of esophageal stenoses caused by a wide range of pathologic conditions including reflux, lye injury, surgery, radiation, and obstructing tumor 2–4 . This technique has been used for the treatment of pharyngoesophageal obstruction from a variety of causes, but no case series data exist using this technique for hypopharyngeal stenoses caused by chemoradiation for head and neck cancer 5,6 …”

Combined retrograde and anterograde hypopharyngeal puncture and dilatation in a child with complete hypopharyngeal stenosis

“…Often, a lumen can be re-created by anterograde or retrograde cannulation of the esophagus with the assistance of fluoroscopy and/or gastroscopy [3]. The traditional treatment of pediatric patients with esophageal strictures is performed using mercury bougies in an anterograde fashion or Tucker dilators Combined retrograde-anterograde hypopharyngeal puncture and dilatation 155 Fig.…”

Retrograde Esophageal Dilation Using Savary Dilators

“…Reports on retrograde dilation techniques in the last 20 years typically have involved combination antegrade and retrograde techniques in which the distal esophagus is visualized using endoscopy, a guidewire is passed in either antegrade or retrograde fashion, and then dilators are passed orally to expand the strictured portion of the esophagus 2–4 . The dilation technique described above is decidedly different from these techniques in that it is strictly retrograde.…”

“…These strictures are quite amenable to antegrade dilation using unguided bougienage, wire guided Savary dilation, or balloon dilation. In the unusual circumstance that passage of an antegrade wire is impossible because of distortions of the anatomy and severity of the stricture, retrograde passage of a guidewire allows for safer passage of antegrade dilation 2–4 . On the occasion of a severe, long stricture, the use of retrograde dilation such as the Eder‐Puestow method may be preferable because of the reported reduced complication rates 5 .…”

“…In the unusual circumstance that passage of an antegrade wire is impossible because of distortions of the anatomy and severity of the stricture, retrograde passage of a guidewire allows for safer passage of antegrade dilation. [2][3][4] On the occasion of a severe, long stricture, the use of retrograde dilation such as the Eder-Puestow method may be preferable because of the reported reduced complication rates. 5 Because of the infrequency of these cases, many modern endoscopy suites are unequipped for, untrained in, or unfamiliar with retrograde techniques.…”