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Updated: Jul 8, 2026

An Ivor Lewis Esophagectomy Designed to Minimize Anastomotic Complications and Optimize Conduit Function
Published on: April 17, 2020
Laparotomy enables retrograde dilatation and stent placement for malignant esophago-respiratory fistula
Alexander Rehders1, Kenko Cupisti, Marcus Schmitt
1Klinik für Allgemein-, Viszeral- und Kinderchirurgie, Heinrich Heine Universität, Düsseldorf, Germany. rehders@med.uni-duesseldorf.de
Background:
Malignant esophageal stenosis with complete obstruction and esophagorespiratory fistula (ERF) is difficult to treat with standard endoscopic techniques.
Case Presentation:
We report a patient in whom with local recurrence of esophageal carcinoma an esophagotracheal fistula occurred. Initially the patient had undergone esophageal resection with interposition of a gastric tube. Due to complete obstruction of the lumen by recurrent tumor conventional transoral stent placement failed. For retrograde dilatation a laparotomy was performed. Via a duodenal incision endoscopic access to the gastric tube was achieved. Using a guidewire the esophageal obstruction was traversed and dilated. Then it was possible to place an esophageal stent via an antegrade approach.
Conclusion:
Open surgery enables a safe access for retrograde endoscopic therapy in patients who had undergone esophageal resection with gastric interposition.
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