UGI Esophagus-COMBINED ANTEGRADE-RETROGRADE RECANALIZATION OF A COMPLETELY OBSTRUCTED ESOPHAGUS BY EUS GUIDED RENDEZVOUS TECHNIQUE

Video Transcription

Introduction, a 99-year-old man with significant cardiac disease on antiplatelets, ASA class 3 and PEC tube for chronic dysphagia, presents to hospital for PEC tube dislodgement.  GI service was consulted for endoscopic replacement of PEC.  These are the keywords.  A completely obstructed esophagus was found on the EGD. By using the PEC tract, an XP scope was inserted into the stomach in a retrograde manner towards the GE junction.  A gastroscope was inserted in an antigrade manner at the GE junction. Under fluoroscopy, it was evident by the position of the scope, the stenosis measured 15 to 20 mm.  Despite the close proximity of both scope tips, translumination was not detected,  and the obstructed esophagus could not be recanalized with guide wire.  The stomach was filled with water by passing XP scope through PEC tract. This allowed for better visualization on the EUS of the anal orifice of the GE junction.  Using EUS and fluoroscopy, 19-gauge FNA needle penetrated the GE junction from the oral orifice.  Schrodinger technique was used to pass the guide wire.  Guide wire was readily inserted from the esophagus into the stomach by using Schrodinger technique.  Axial stand passed along the guide wire.  Then, we can see axial stand deployed successfully.  Axial stand noted on fluoroscopy to sit within stenosis with proximal flange in esophagus and distal flange in gastric cardia.  Then, we can see contrast flowed through stand freely into stomach.  No evidence of leak on contrast study across stand and there is confirmed patency of GE junction as evident by contrast flowing freely into the stomach.  Light of the other scope could be seen and confirmed stand was patent.  Patient was followed for 6 months and able to tolerate liquids and soft food for first time in 8 years.  Clinical implications Combined anti-grid, retro-grid endoscopic recanalization technique is feasible in difficult cases.  But in certain cases, only transillumination and fine-needle technique are not safe enough to recanalize the stenosis.  Therefore, EUS guided rendezvous technique can make the process of fine-needle penetration more visible.  Conclusion Combined anti-grid, retro-grid endoscopic recanalization with EUS guided rendezvous technique is more visible and safer for completely obstructive esophagus therapy.

Video Summary

The video transcript features a case study of a 99-year-old man with significant cardiac disease who presents to the hospital for a dislodged PEC tube. GI service is consulted for endoscopic replacement of the tube. During the procedure, a completely obstructed esophagus is found. Attempts to recanalize the esophagus using a guide wire are unsuccessful. The stomach is filled with water for better visualization, and a 19-gauge FNA needle penetrates the GE junction to pass the guide wire. The guide wire is successfully inserted, and an axial stand is deployed within the stenosis. Contrast flows freely into the stomach, confirming patency of the GE junction. The patient is able to tolerate liquids and soft food for the first time in 8 years. The use of combined anti-grid, retro-grid endoscopic recanalization with EUS-guided rendezvous technique is deemed feasible and safer for therapy in completely obstructive esophagus cases. No credits were provided in the transcript.

Asset Subtitle

Honorable Mention

Keywords

cardiac disease

dislodged PEC tube

endoscopic replacement

obstructed esophagus

EUS-guided rendezvous technique