de Campos Sara Teles, Rio-Tinto Ricardo, Fidalgo Paulo, Bispo Miguel, Marques Susana, Devière Jacques
Department of Gastroenterology, Digestive Oncology Unit, Champalimaud Foundation, Lisbon, Portugal.
Department of Gastroenterology, Hepatopancreatology, and Digestive Oncology, Erasmus University Hospital, Université Libre de Bruxelles, Brussels, Belgium.
GE Port J Gastroenterol. 2021 Sep 30;29(6):420-425. doi: 10.1159/000518913. eCollection 2022 Nov.
The approach to esophageal obstruction or discontinuity remains challenging and often involves complex reconstructive surgeries. The rendezvous endoscopic technique might be interesting in cases of complete esophageal obstruction.
Herein we describe a successful case of endoscopic recanalization of the esophageal lumen in a patient with a long-standing esophageal discontinuity resulting from several surgeries and chemoradiation for a squamous cell carcinoma of the hypopharynx, ending in a major cervical amputation, construction of a neopharynx, and definitive surgical closure of the superior esophagus with a PEG placement. With a rendezvous technique (peroral and through the gastrostomy) and under radiographic guidance, puncture from the neopharynx into the distal esophagus was performed, followed by balloon dilation and covered metal stent placement in order to reconstruct a neoesophagus. Five weeks later, the stent was removed (using a stent-in-stent technique). No complications occurred. The patient has been able to eat soft food and is being kept under regular endoscopic surveillance to control/treat a luminal stenosis of the neoesophagus.
This case report illustrates a successful endoscopic treatment of post-surgical complete esophageal obstruction. This approach should be considered in the therapeutic armamentarium of these difficult clinical settings.
处理食管梗阻或连续性中断仍然具有挑战性，通常需要进行复杂的重建手术。对于完全性食管梗阻病例，会师内镜技术可能具有一定价值。
在此，我们描述了一例成功的内镜下食管腔再通病例。该患者因下咽鳞状细胞癌接受多次手术及放化疗后导致长期食管连续性中断，最终进行了颈部大截肢、新咽造瘘术，并通过经皮内镜下胃造口术（PEG）对食管上段进行了确定性手术闭合。在影像学引导下，采用会师技术（经口和经胃造口），从新咽穿刺至远端食管，随后进行球囊扩张并置入覆膜金属支架以重建新食管。五周后（采用支架套支架技术）取出支架。未发生并发症。患者已能够进食软食，并定期接受内镜监测以控制/治疗新食管的管腔狭窄。
本病例报告展示了对术后完全性食管梗阻的成功内镜治疗。在这些困难临床情况的治疗手段中应考虑采用这种方法。
