Vitali Francesco, Nägel Andreas, Pfeifer Lukas, Goetz Martin, Siebler Jürgen, Neurath Markus F, Rath Timo
Division of Gastroenterology, Department of Internal Medicine I, Ludwig Demling Endoscopy Center of Excellence, Friedrich-Alexander-University Erlangen-Nuernberg, Ulmenweg 18, 91054, Erlangen, Germany.
Division of Gastroenterology and Oncology, Department of Internal Medicine IV, Klinikum Sindelfingen-Böblingen, Böblingen, Germany.
Surg Endosc. 2021 Jun;35(6):3184-3188. doi: 10.1007/s00464-021-08313-4. Epub 2021 Feb 1.
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.
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.
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.
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.
完全性食管梗阻（CEO）是放化疗后一种罕见的并发症，会严重损害生活质量。在本研究中，我们评估了两种不同的内镜技术用于CEO患者管腔重建的效果。
纳入17例患者。采用顺行途径进行食管再通（A组）或通过顺行与逆行联合再通及扩张（CARD，B组）。比较两组间技术成功率、并发症及随访（FU）期间吞咽困难的发生情况。
A组（n = 6）由一名内镜医师进行食管再通，中位时间为47分钟。2例患者顺行再通导致假腔形成（即黏膜下隧道形成），随后发生纵隔炎。B组对11例患者进行了21次CARD操作，技术成功率为100%。与A组相比，操作时间更长；然而，B组未观察到术中或术后并发症。
根据我们的经验和队列研究，CARD是一种成功的CEO再通方法，与顺行再通相比，其安全性更优。需要进一步进行随机研究以评估CARD治疗CEO的效果。
