Surgical Endoscopy

, Volume 32, Issue 10, pp 4256–4262 | Cite as

Rendezvous endoscopic recanalization for complete esophageal obstruction

  • Stefano Fusco
  • Thomas Kratt
  • Cihan Gani
  • Dietmar Stueker
  • Daniel Zips
  • Nisar P. Malek
  • Martin GoetzEmail author


Background and study aim

Complete esophageal obstruction after (chemo)radiation for head and neck cancers is rare. However, inability to swallow one’s own saliva strongly inflicts upon quality of life. Techniques for endoscopic recanalization in complete obstruction are not well established. We assessed the efficacy and safety of rendezvous recanalization.

Patients and methods

We performed a retrospective review of all patients who underwent endoscopic recanalization of complete proximal esophageal obstruction after radiotherapy between January 2009 and June 2016. Technical success was defined as an ability to pass an endoscope across the recanalized lumen, clinical success by changes in the dysphagia score. Adverse events were recorded prospectively.


19 patients with complete obstruction (dysphagia IV°), all of whom had failed at least one trial of conventional dilatation, underwent recanalization by endoscopic rendezvous, a combined approach through a gastrostomy and perorally under fluoroscopic control. Conscious sedation was used in all patients. In 18/19 patients (94.7%), recanalization was technically successful. In 14/18 patients (77.8%), the post-intervention dysphagia score changed to ≤ II. Three patients had their PEG removed. Factors negatively associated with success were obstruction length of 50 mm; and tumor recurrence for long-term success. No severe complications were recorded.


Rendezvous recanalization for complete esophageal obstruction is a reliable and safe method to re-establish luminal patency. Differences between technical and clinical success rates highlight the importance of additional functional factors associated with dysphagia. Given the lack of therapeutic alternatives, rendezvous recanalization is a valid option to improve dysphagia.


Esophageal obstruction Stenosis Recanalization Radiochemotherapy Head and neck cancer 


Compliance with ethical standards


Stefano Fusco, Thomas Kratt, Cihan Gani, Dietmar Stueker, Daniel Zips, Nisar P. Malek, and Martin Goetz have no conflicts of interest or financial ties to disclose.


  1. 1.
    Wang JJ, Goldsmith TA, Holman AS, Cianchetti M, Chan AW (2012) Pharyngoesophageal stricture after treatment for head and neck cancer. Head Neck 34(7):967–973CrossRefGoogle Scholar
  2. 2.
    Laurell G, Kraepelien T, Mavroidis P, Lind BK, Fernberg JO, Beckman M, Lind MG (2003) Stricture of the proximal esophagus in head and neck carcinoma patients after radiotherapy. Cancer 97(7):1693–1700CrossRefGoogle Scholar
  3. 3.
    Dellon ES, Cullen NR, Madanick RD, Buckmire RA, Grimm IS, Weissler MC, Couch ME, Shaheen NJ (2010) Outcomes of a combined antegrade and retrograde approach for dilatation of radiation-induced esophageal strictures (with video). Gastrointest Endosc 71(7):1122–1129CrossRefGoogle Scholar
  4. 4.
    Gonzalez JM, Vanbiervliet G, Gasmi M, Grimaud JC, Barthet M (2016) Efficacy of the endoscopic rendez-vous technique for the reconstruction of complete esophageal disruptions. Endoscopy 48(2):179–183PubMedGoogle Scholar
  5. 5.
    O’Sullivan GC, O’Brien MG (1997) Successful retrograde dilation and oesophageal conservation after failed antegrade management of a reflux stricture. Endoscopy 29(2):141CrossRefGoogle Scholar
  6. 6.
    Grooteman KV, Wong Kee Song LM, Vleggaar FP, Siersema PD, Baron TH (2014) Functional outcome of patients treated for radiation-induced complete esophageal obstruction after successful endoscopic recanalization (with video). Gastrointest Endosc 80(1):175–181CrossRefGoogle Scholar
  7. 7.
    Garcia A, Flores RM, Schattner M, Kraus D, Bains MS, Wong RJ, Rizk N, Markowitz A, Gerdes H, Shike M (2006) Endoscopic retrograde dilation of completely occlusive esophageal strictures. Ann Thorac Surg 82(4):1240–1243CrossRefGoogle Scholar
  8. 8.
    Vakil N, Morris AI, Marcon N, Segalin A, Peracchia A, Bethge N, Zuccaro G, Bosco JJ, Jones WF (2001) A prospective, randomized, controlled trial of covered expandable metal stents in the palliation of malignant esophageal obstruction at the gastroesophageal junction. Am J Gastroenterol 96(6):1791–1796CrossRefGoogle Scholar
  9. 9.
    Ahlberg A, al-Abany M, Alevronta E, Friesland S, Hellborg H, Mavroidis P, Lind BK, Laurell G (2010) Esophageal stricture after radiotherapy in patients with head and neck cancer: experience of a single institution over 2 treatment periods. Head Neck 32(4):452–461PubMedGoogle Scholar
  10. 10.
    Baschnagel AM, Yadav S, Marina O, Parzuchowski A, Lanni TB Jr, Warner JN, Parzuchowski JS, Ignatius RT, Akervall J, Chen PY et al (2014) Toxicities and costs of placing prophylactic and reactive percutaneous gastrostomy tubes in patients with locally advanced head and neck cancers treated with chemoradiotherapy. Head Neck 36(8):1155–1161CrossRefGoogle Scholar
  11. 11.
    Pohar S, Demarcantonio M, Whiting P, Crandley E, Wadsworth J, Karakla D (2015) Percutaneous endoscopic gastrostomy tube dependence following chemoradiation in head and neck cancer patients. Laryngoscope 125(6):1366–1371CrossRefGoogle Scholar
  12. 12.
    Crombie JM, Ng S, Spurgin AL, Ward EC, Brown TE, Hughes BG (2015) Swallowing outcomes and PEG dependence in head and neck cancer patients receiving definitive or adjuvant radiotherapy +/- chemotherapy with a proactive PEG: a prospective study with long term follow up. Oral Oncol 51(6):622–628CrossRefGoogle Scholar
  13. 13.
    Lew RJ, Shah JN, Chalian A, Weber RS, Williams NN, Kochman ML (2004) Technique of endoscopic retrograde puncture and dilatation of total esophageal stenosis in patients with radiation-induced strictures. Head Neck 26(2):179–183CrossRefGoogle Scholar
  14. 14.
    Wagh MS, Yang D, Chavalitdhamrong D, Draganov PV (2014) Per-oral endoscopic tunneling for restoration of the esophagus (POETRE). Gastrointest Endosc 80(2):330CrossRefGoogle Scholar
  15. 15.
    Mavrogenis G, Moreels TG, Chevaux JB, Thoma M, Deprez P, Piessevaux H (2015) Recanalization of a complete postradiation esophageal obstruction with endoscopic submucosal dissection techniques. Gastrointest Endosc 81(6):1476CrossRefGoogle Scholar

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© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Innere Medizin IUniversitätsklinikum TübingenTübingenGermany
  2. 2.Department of Internal MedicineSpital am LimmatSchlierenSwitzerland
  3. 3.Department of Radiation OncologyTuebingen University HospitalTübingenGermany
  4. 4.Department of General, Visceral and Transplant SurgeryTuebingen University HospitalTübingenGermany

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