Retrograde radiological gastrostomy technique and retrograde stent placement in a completely occluded cervical esophagus
Affiliation
Radiology, The Christie Hospital, ManchesterIssue Date
2021
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Malignant obstruction of the cervical esophagus presents some anatomical and technical challenges when considering radiologic or endoscopic intervention. This case report describes the failure of antegrade access to place a gastrostomy tube and stent due to complete luminal occlusion from an esophageal tumor. The ultrasound-guided percutaneous gastric puncture was performed to achieve retrograde pneumodistension to allow radiologic gastrostomy insertion. Subsequently, the cervical esophagus was retrogradely cannulated via insertion of a guidewire from the gastrostomy site. A distal release esophageal stent was then inserted over the wire and deployed from the mouth in an antegrade manner. However, due to the unpredictable proximal shortening of distal release stents, this stent was eventually shortened and displaced so that it no longer covered the top of the tumor stricture, and further antegrade access failed. Once more, a retrograde access approach was adopted via the gastrostomy stoma, a guidewire and catheter were passed retrogradely through the original stent and out through the mouth. A distal release stent system was then inserted in a retrograde manner via the gastrostomy stoma, effectively making it a proximal release stent which enabled more precise positioning of the stent above the tumor. Palliation was achieved until death, and beyond expected mean survival.Citation
Bi Y, Edwards D, Mullan D, Laasch H-U. Retrograde Radiological Gastrostomy Technique and Retrograde Stent Placement in a Completely Occluded Cervical Esophagus. Cureus. 2021 Mar 26Journal
CureusDOI
10.7759/cureus.14121PubMed ID
33927929Additional Links
https://dx.doi.org/10.7759/cureus.14121Type
ArticleLanguage
enae974a485f413a2113503eed53cd6c53
10.7759/cureus.14121
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