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Endoscopic recanalization of complete esophageal obstruction

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Abstract

Background and aims

Complete esophageal obstruction (CEO) is a rare complication after radiochemotherapy that dramatically impairs quality of life. Within this study, we assessed the outcome of two different endoscopic techniques for lumen restoration in patients with CEO.

Methods

17 patients were included. Esophageal recanalization was performed in an antegrade approach (Group A) or through combined antegrade and retrograde recanalization and dilatation (CARD, Group B). Technical success, complications, and dysphagia development during follow-up (FU) were compared between the groups.

Results

In Group A (n = 6), esophageal recanalization was performed by a single endoscopist with a median duration of 47 min. In two patients, antegrade recanalization led to formation of a false lumen (i.e., submucosal tunneling) followed by mediastinitis. In Group B, 21 CARD procedures were performed in 11 patients with a technical success rate of 100%. Procedure time was longer compared to Group A; however, no intra- or postprocedural complications were observed in Group B.

Conclusions

In our experience and cohort, CARD was a successful procedure for recanalization of CEO, which exhibits a more favorable safety profile over antegrade recanalization. Further randomized studies to evaluate the treatment of CEO with CARD are needed.

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Authors and Affiliations

  1. Division of Gastroenterology, Department of Internal Medicine I, Ludwig Demling Endoscopy Center of Excellence, Friedrich-Alexander-University Erlangen-Nuernberg, Ulmenweg 18, 91054, Erlangen, Germany

    Francesco Vitali, Andreas Nägel, Lukas Pfeifer, Jürgen Siebler, Markus F. Neurath & Timo Rath

  2. Division of Gastroenterology and Oncology, Department of Internal Medicine IV, Klinikum Sindelfingen-Böblingen, Böblingen, Germany

    Martin Goetz

Authors
  1. Francesco Vitali
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  2. Andreas Nägel
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  3. Lukas Pfeifer
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  4. Martin Goetz
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  5. Jürgen Siebler
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  6. Markus F. Neurath
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  7. Timo Rath
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Correspondence to Timo Rath.

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Disclosures

Francesco Vitali, Andreas Nägel, Lukas Pfeifer, Martin Goetz, Jürgen Siebler, Markus F. Neurath, and Timo Rath have no conflicts of interest or financial ties to disclose.

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Vitali, F., Nägel, A., Pfeifer, L. et al. Endoscopic recanalization of complete esophageal obstruction. Surg Endosc 35, 3184–3188 (2021). https://doi.org/10.1007/s00464-021-08313-4

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  • DOI: https://doi.org/10.1007/s00464-021-08313-4

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