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Endoscopic Vacuum Therapy for the Treatment of Anastomotic Leakage after Total Gastrectomy with Esophagojejunostomy

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Retrograde endoscopic-assisted esophageal dilation.

Alexander Langerman¹, Kerstin M Stenson, Mark K Ferguson

¹Section of Otolaryngology Head and Neck Surgery, Department of Surgery, University of Chicago Medical Center and Pritzker School of Medicine, Chicago, IL 60637, USA.

Journal of Gastrointestinal Surgery : Official Journal of the Society for Surgery of the Alimentary Tract

|May 5, 2010

Summary

This summary is machine-generated.

A novel retrograde esophagoscopy technique aids in dilating difficult cervical esophageal strictures. This method, using an existing gastrostomy, safely guides dilation and preserves the lumen for future treatment.

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Area of Science:

Gastroenterology
Oncology
Surgical Endoscopy

Background:

Esophageal strictures are a common complication following chemoradiotherapy for head and neck cancers.
These strictures typically form in the cervical esophagus within the radiation field.
Identifying the esophageal lumen for dilation can be challenging, risking false lumen creation.

Purpose of the Study:

To present a retrograde esophagoscopy method for identifying the esophageal lumen.
To facilitate confident dilation of challenging cervical esophageal strictures.
To describe a technique for managing esophageal strictures post-cancer treatment.

Main Methods:

Utilizing retrograde esophagoscopy through an established gastrostomy to visualize the esophageal lumen.
Passing a guidewire from below the stricture under endoscopic guidance.
Performing bougie dilation of the esophageal stricture over the guidewire.

Main Results:

Successful identification of the esophageal lumen was achieved.
Confident dilation of the cervical esophageal stricture was performed.
A modified feeding tube was often placed post-dilation to maintain lumen patency.

Conclusions:

Retrograde esophagoscopy offers a safe and effective approach for difficult cervical esophageal strictures.
This technique is particularly beneficial for patients with an existing gastrostomy.
The method facilitates accurate guidewire placement for subsequent dilation and lumen preservation.