Retrograde approach to pharyngo-esophageal obstruction.

Department of Otorhinolaryngology, University Hospital Maastricht, The Netherlands. BACKGROUND: The entrance of the esophagus has to be identified for treatment of a pharyngo-esophageal obstruction. If transoropharyngeal identification is unsuccessful, a retrograde approach might be indicated. METHODS: By way of a mini-laparotomy and gastrotomy, a flexible gastroscope 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 hypertrophy of the cricopharyngeal muscle, into the oral cavity. Thereafter antegrade dilatation and laser assisted myotomy could be performed. In another patient with a membranous obstruction of the esophageal entrance due to radiotherapy, the occlusion was perforated transoropharyngeally and bluntly dilatated guided by the light from the gastroscope. RESULTS: In both cases the esophageal passage was restored. No complications occurred as a result of the procedures. CONCLUSIONS: The retrograde approach may be a good alternative when antegrade identification of the esophageal entrance fails