Safety and Efficacy of Combined Antegrade and Retrograde Endoscopic Dilation for Complete Esophageal Obstruction: a Systematic Review and Meta-analysis

Overview

Journal Ann Gastroenterol

Specialty Gastroenterology

Date 2019 Jul 3

PMID 31263358

Citations 8

Authors

Mahendran Jayaraj

Babu P Mohan

Harmeet Mashiana

Rajesh Krishnamoorthi

Douglas G Adler

Affiliations

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Abstract

Background: Complete esophageal obstruction (CEO) due to occlusive proximal stricture occurs after chemoradiation for head and neck cancers. A combined antegrade and retrograde endoscopic technique with controlled recanalization and dilation (CARD) has been shown to be an effective and safe method for regaining and maintaining esophageal luminal patency in the short term.

Methods: We conducted a comprehensive search of multiple electronic databases and conference proceedings, including PubMed, EMBASE, and Web of Science databases (from inception through November 2018), to identify studies that reported the outcomes of CARD. The primary outcomes were the pooled rates of technical and clinical success, specifically improvement in dysphagia and independence from percutaneous endoscopic gastrostomy (PEG)-tube feeds. The secondary outcomes were the need for repeat dilations and the risks of complications, such as pneumomediastinum, perforation, and death.

Results: From a total of 19 studies (229 cases and 251 procedures) the calculated technical success rate was 88.9% (95% confidence interval [CI] 83.9-92.5, =0). The rates of improvement in dysphagia and being PEG-tube free were 58.4% (95%CI 50-66.3, =12.6) and 43.5% (95%CI 34.1-53.4, =30.6), respectively. The pooled rate of repeat dilatations was 78.9% (95%CI 69.7-85.8, =15.2). The risks of pneumomediastinum, perforation and death were 9.9% (95%CI 6.2-15.6, =0), 8% (95%CI 4.8-13, =0), and 6.8% (95%CI 3.4-13.1, =0), respectively. Minimal heterogeneity was noted in the analysis.

Conclusions: The CARD procedure for CEO has a high technical success rate, but also a high rate of repeat dilations. Given its complexity and associated adverse events, this procedure should be restricted to centers with a high level of expertise.

Citing Articles

Combined Anterograde and Retrograde Endoscopic Management of Complete Esophageal Obstruction in Absence of Fluoroscopic Guidance.

Maan M, Medina Morales J, Choi C, Ahmad M, Hajifathalian K, Wang W ACG Case Rep J. 2025; 12(2):e01594.

PMID: 39886012 PMC: 11778083. DOI: 10.14309/crj.0000000000001594.

Combined antegrade and retrograde dilation (CARD) for management of complete esophageal obstruction: Multicenter case series.

Hayat U, Khan Y, Deivert D, Obuch J, Altaf A, Boger J Endosc Int Open. 2024; 12(10):E1199-E1205.

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Robot-assisted oesophagectomy (Ivor-Lewis) for a complex stenosis previously managed by open gastrostomy tube placement.

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Endoscopic Reconstruction of an Oral Feeding Route Using a Rendezvous Approach.

Teles de Campos S, Rio-Tinto R, Fidalgo P, Bispo M, Marques S, Deviere J GE Port J Gastroenterol. 2022; 29(6):420-425.

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Percutaneous endoscopic gastrostomy and jejunostomy: Indications and techniques.

Fugazza A, Capogreco A, Cappello A, Nicoletti R, Da Rio L, Galtieri P World J Gastrointest Endosc. 2022; 14(5):250-266.

PMID: 35719902 PMC: 9157691. DOI: 10.4253/wjge.v14.i5.250.

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