Endoscopic recanalization using rendez-vous technique for complete upper esophageal obstruction: a case report

Esophageal obstruction is a rare late adverse effect after head and neck cancer radiotherapy and chemotherapy treatment. The approach to complete esophageal obstruction is not well established in cases where malignant recurrence has been ruled out. We hereby present the case of a patient that presented with total dysphagia and multiple aspiration episodes. A minimally invasive endoscopic management was proposed for this complete esophageal obstruction. The endoscopic rendez-vous technique for esophageal recanalization requires an antegrade access through the mouth and a retrograde access through a feeding gastrostomy. Two interventional endoscopists locate and measure the length of the stenosis under fluoroscopic control. Once the axis of the two endoscopes is aligned, recanalization is achieved using a needle knife incision followed by balloon dilatation over a guide wire. Nasogastric (NG) tube insertion is performed at the end of the procedure to prevent premature recurrence of the stenosis. Subsequent dilatations were necessary after this procedure to obtain a satisfactory functional result. Post-operative speech therapy follow-up was also required. The endoscopic rendez-vous technique is hence a reliable and safe therapeutic option for short stenosis with transillumination. A multidisciplinary approach and long-term follow-up are mandatory in order to maximize the functional benefit for these complex patients.