RETROGRADE APPROACH TO PHARYNGOESOPHAGEAL OBSTRUCTION

Background: The entrance of the esophagus has to be identified for tre atment of a pharyngo-esophageal obstruction. If transoropharyngeal ide ntification is unsuccessful, a retrograde approach might be indicated. Methods: By way of a mini-laparotomy and gastrotomy, a flexible gastr oscope can be passed into the esophagus, In one patient with a Zenker' s diverticulum, a guidewire was inserted through the accessory channel of the gastroscope and passed through a stenosis, caused by marked hy pertrophy of the cricopharyngeal muscle, into the oral cavity, Thereaf ter antegrade dilatation and laser assisted myotomy could be performed . In another patient with a membranous obstruction of the esophageal e ntrance due to radiotherapy, the occlusion was perforated transorophar yngeally and bluntly dilatated guided by the light from the gastroscop e, Results: In both cases the esophageal passage was restored. No comp lications occurred as a result of the procedures. Conclusions: The ret rograde approach may be a good alternative when antegrade identificati on of the esophageal entrance fails.