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Updated: Oct 4, 2026

An Ivor Lewis Esophagectomy Designed to Minimize Anastomotic Complications and Optimize Conduit Function
Published on: April 17, 2020
Combined antegrade and retrograde dilation: a new endoscopic technique in the management of complex esophageal
R Bueno1, S J Swanson, M T Jaklitsch
1Division of Thoracic Surgery, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts 02115, USA.
Background:
Esophageal strictures that cause complete obstruction are often difficult to dilate with standard bougienage techniques.
Methods:
A new technique was developed and applied, combined antegrade and retrograde dilation, for dilatation of complex esophageal strictures. The stomach is accessed and an endoscope (9.8 mm diameter) is directed under fluoroscopy in a retrograde fashion into the distal esophagus. A guidewire with a hydrophilic coating is advanced through the stricture and then pulled through the mouth with a simultaneously placed proximal endoscope. The guidewire is then used as a guide for antegrade esophageal dilatation.
Results:
Ten patients with complex esophageal strictures (with and without fistulas) were treated with this technique. Three required a second combined antegrade and retrograde dilation procedure. All strictures were dilated and no perforations occurred.
Conclusions:
Combined antegrade and retrograde dilation is a safe and effective technique for dilation of complex obstructing esophageal lesions.
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