S5370 Combined Antegrade and Retrograde Endoscopic Dilation Technique With Controlled Recanalization of Complete Esophageal Obstruction From Upper Esophageal Stricture

Introduction: Complete esophageal obstruction (CEO) is a rare cause of esophageal strictures. Standard dilation techniques are not usually feasible due to altered esophageal anatomy and higher complication rates. The most common cause of CEO is radiation therapy for cancer. Combined antegrade and retrograde endoscopic dilation (CARD) has a technical success rate of 89% and dysphagia improvement rate of 58.4%. We present a case of luminal restoration of CEO with CARD. Case Description: A 68-year-old-man with a history of radiation treatment for laryngeal cancer presented for esophagogastroduodenoscopy (EGD) with CARD for luminal restoration. He reported severe dysphagia and odynophagia for the past 2 years and relied on a percutaneous gastrostomy (PEG) tube for feeds. Modified barium swallow showed a complete luminal obstruction at the upper esophagus. Given inability to traverse the upper esophageal stenosis with a pediatric antegrade endoscope, we proceeded to remove the existing 20 Fr PEG tube and pass a pediatric endoscope in retrograde fashion into the esophagus. A dilator wire was unable to pass through a complete obstruction at the proximal esophagus. Using the pediatric upper endoscope advanced in an antegrade fashion, a Savary guide wire was advanced, unable to pass through the stricture. Using the pediatric forceps, the thin mucosa was sheared retrograde and the Savary wire was grasped and left in the stomach. The patient then underwent anterograde bougie cap dilation of 7-8 mm followed by 9-10 mm using the upper endoscope. The stenosis was able to be traversed, followed by serial dilations with luminal restoration. Discussion: Several endoscopic procedures have been documented for recanalization of CEO. Including antegrade approach with traumatic forward probing and luminal dilation with fluoroscopy. CARD is preferred due to success rates and favorable safety profile over sole antegrade approach. This case shows the effectiveness of CARD in cases of CEO failing standard dilation techniques.