Endoscopic management of radiation-induced complete upper esophageal obstruction with an antegrade-retrograde rendezvous technique

Background: Esophageal strictures occur in 3% to 4% of patients with head and neck cancer who undergo radiation therapy Some patients develop complete obstruction of the upper esophagus. Antegrade dilatation is often unsuccessful and many of these patients require surgery Objective: To describe the outcomes and complications of an endoscopic antegrade-retrograde rendezvous procedure to restore esophageal patency Design: Retrospective review of 8 cases treated with an endoscopic rendezvous procedure between August 2001 and April 2005. Medical records of consenting patients were abstracted for clinical history, procedural success, complications, and follow-up. Setting: A large tertiary referral center. Patients: Eight patients with head and neck or upper esophageal cancer and complete upper esophageal obstruction from radiation stricturing who under-went an attempted rendezvous procedure. Main Outcome Measurements: Clinical procedural success, reported adverse events. Results: Seven patients were men, and median age was 65 years. The median interval between radiation and the rendezvous procedure was 11 months. In 7 of 8 cases esophageal patency was restored and no major complications occurred. Two esophageal microperforations resolved without intervention. Most patients responded well to subsequent serial dilations and many discontinued gastrostomy tube use. Limitations: Retrospective, selection bias. Conclusions: An antegrade-retrograde rendezvous technique with subsequent dilation appears to be safe and effective for endoscopic management of complete upper esophageal obstruction induced by radiotherapy and can obviate the need for esophageal resection.