Video

Video 77.2 Rendezvous esophageal reconnection and self-expandable metal stent insertion

Rendezvous esophageal reconnection and self-expandable metal stent insertion. This 54-year-old man had a total laryngectomy and irradiation for laryngeal cancer 4 years prior and has had total aphagia requiring enteral feeding for the past 3 years. Per os endoscopy demonstrated a tiny, non-patent esophageal inlet. Endoscopy through the patient's gastrostomy orifice demonstrated complete obstruction, and attempts to pass an endoscopic ultrasound (EUS) needle into the hypopharynx from the esophagus were unsuccessful. Ultimately, an endoscopic retrograde cholangiopancreatography (ERCP) catheter and guidewire passed through a per os endoscope could reestablish continuity with the aid of biopsy forceps. Following guidewire insertion into the esophagus, the neolumen was dilated with an 8-mm balloon followed by placement of a 10-mm partially covered self-expandable metal stent. The latter was subsequently clipped in place distally using the endoscope placed through the gastrostomy. Four weeks later, the stent was retrieved and the patient dilated to 42 Fr. Following several additional dilations, he has remained dysphagia free.