Combined antegrade and retrograde dilation: a new endoscopic technique in the management of complex esophageal obstruction

Background: Esophageal strictures that cause complete obstruction are often difficult to dilate with standard bougienage techniques. Methods: A new technique was developed and applied, combined antegrade and retrograde dilation, for dilatation of complex esophageal strictures. The s tomach is accessed and an endoscope (9.8 mm diameter) is directed under flu oroscopy in a retrograde fashion into the distal esophagus. A guidewire wit h a hydrophilic coating is advanced through the stricture and then pulled t hrough the mouth with a simultaneously placed proximal endoscope. The guide wire is then used as a guide for antegrade esophageal dilatation. Results: Ten patients with complex esophageal strictures (with and without fistulas) were treated with this technique. Three required a second combine d antegrade and retrograde dilation procedure. All strictures were dilated and no perforations occurred. Conclusions: Combined antegrade and retrograde dilation is a safe and effec tive technique for dilation of complex obstructing esophageal lesions.