Complete obstruction of the esophagus after chemoradiotherapy for esophageal cancer is very rare and extremely difficult to treat. We report a recanalization using the rendezvous technique with endoscopic ultrasound (EUS) using a forward-viewing echoendoscope (TGF-UC260J; Olympus Medical) ( Fig. 1 ).
Fig. 1.
Photograph of forward-viewing echoendoscope.
A 78-year-old woman developed complete obstruction of the lower esophagus after chemoradiotherapy for esophageal cancer ( Fig. 2 ) and was fed via percutaneous endoscopic gastrostomy for 7 years. The patient strongly desired to resume oral intake with minimally invasive treatment, so endoscopic treatment was performed. First, a thin endoscope was inserted through the gastrostomy route and advanced in a retrograde manner to the site of the esophageal obstruction ( Video 1 ). A forward-viewing echoendoscope was then inserted orally and advanced to the obstruction site.
Fig. 2.
Complete obstruction of the esophagus after chemoradiotherapy for esophageal cancer: a, b fluoroscopic images; c endoscopic image.
Video 1 Use of a forward-viewing echoendoscope in endoscopic ultrasound-guided recanalization of complete obstruction of the esophagus after chemoradiotherapy for esophageal cancer.
Injection of saline solution into the esophagus through the retrograde scope made it possible to recognize the esophageal lumen on the anal side of the obstruction by EUS ( Fig. 3 ). The esophageal lumen on the anal side of the obstruction was punctured with a 19G needle under EUS guidance, and the puncture needle was confirmed, by fluoroscopic contrast and also through the retrograde endoscope, to be in the esophageal lumen. A guidewire was placed in the esophagus on the anal side of the obstruction and a balloon catheter was used to dilate the obstruction site, allowing passage of the scope ( Fig. 4 ). A total of four balloon dilations and one local steroid injection were required to maintain patency.
Fig. 3.
Endoscopic ultrasonogram showing saline solution injected from the retrograde scope into the esophageal lumen on the anal side of the obstruction.
Fig. 4.
Endoscopic image after balloon dilation of the site of the obstruction to 10 mm.
There have been several reports of treatment of complete esophageal obstruction using the EUS rendezvous technique 1 2 , but none has used forward-viewing EUS. When puncturing the esophagus, which is a linear organ, forward-viewing EUS is safe and easy given the angle of the needle advanced from the scope, and the risk of perforation is low because the needle can be aimed at the center of the scar site for puncture and dilation ( Fig. 5 ).
Fig. 5.
Schematic images showing the angle of advancement of the needle from a conventional echoendoscope and a forward-viewing echoendoscope.
Endoscopy_UCTN_Code_TTT_1AO_2AN
Footnotes
Competing interests The authors declare that they have no conflict of interest.
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References
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