Endoscopic Recanalization of a Long Segment Esophageal Obstruction Using the Combined Antegrade and Retrograde Rendezvous Procedure

Abstract

The combined antegrade and retrograde endoscopic rendezvous technique effectively restores patency for esophageal short-segment obstructing strictures (<3 cm). However, long-segment strictures typically require complex surgery, with endoscopic management rarely reported. We report a 44-year-old man with a 9 cm esophageal obstruction due to peptic stricture who was at high risk of esophageal resection due to severe cardiac disease and prior abdominal surgeries. He underwent successful recanalization using a rendezvous technique. Serial dilations with subsequent esophageal stenting restored luminal patency. This case highlights the feasibility of an endoscopic approach as a safe and effective alternative to surgery in long-segment peptic strictures.

Keywords: endoscopic dilation; esophageal stricture; rendezvous technique; stricture management.

Figure 1.

Retrograde endoscopic access was achieved through an upper midline abdominal incision.

Figure 2.

(A) Initial fluoroscopy demonstrated a narrowing at the distal esophagus, with no passage of contrast through the affected segment. (B) Fluoroscopic imaging confirmed the sagittal and coronal alignment of both endoscopes, demonstrating a 9 cm axial gap between their tips. A soft tip guidewire was successfully advanced distally across the stricture after multiple attempts. (C) Sequential antegrade and retrograde dilation was performed using 6–8 mm through-the-scope balloons under fluoroscopic guidance.

Figure 3.

(A) Final fluoroscopic assessment confirmed the correct positioning of the esophageal stent. (B) Fully covered self-expandable metallic esophageal stent was deployed and secured with 2 Resolution Clips (Boston Scientific, Boston, MA).