Surgical treatment of a rare complication after endoscopic stent placement for anastomotic leakage after esophageal resection

Abstract

The best approach to achieve cure in esophageal cancer is a combination of chemo-radiation and surgery. However, complications occur in half of patients. The current report, reports a rare but severe complication: Complete obstruction of the esophagus, induced by preoperative chemo-radiation therapy. Normally, strictures are treated by repeated dilatations, however, in case of complete obstruction, the perforation rate of standard blind anterograde wire access and dilation is severely increased. In order to minimize the risk of perforations, the rendezvous technique was introduced. This technique involves an anterograde approach in combination with a retrograde approach in order to open and dilatate the esophagus. While technical success rates between 83% and 100% have been reported in literature, data on clinical outcomes are scarcer. The limited amount of studies available claim that success was achieved in almost half of patients. The patient in our case currently has an oral diet without restrictions and rates his quality of life with a VAS-score ten out of ten.

Keywords: Esophageal cancer; Esophageal obstruction; Rendezvous procedure; Anterograde dilatation; Combined anterograde-retrograde endoscopic dilatation

Core tip: A rare but severe complication of chemo-radiation of the esophagus, in case of esophageal cancer, is a complete esophageal obstruction. Blind anterograde wire access and dilatation leads to a higher risk of perforation, due to lack of visualization and a disrupted anatomy. For this reason the rendezvous technique was introduced, which involves an anterograde approach in combination with a retrograde approach in order to open and dilatate the esophagus.