Endoscopy 2016; 48(10): 952
DOI: 10.1055/s-0042-110567
Letters to the editor
© Georg Thieme Verlag KG Stuttgart · New York

Reply to Mavrogenis et al.

Jean-Michel Gonzalez
,
Marc Barthet
Further Information

Publication History

submitted 01 June 2016

accepted after revision 14 June 2016

Publication Date:
26 September 2016 (online)

We received and paid careful attention to the letter written by Mavrogenis et al. First, we would like to thank them very much for reacting to our paper. We recognize that the approach consisting of endoscopic submucosal dissection (ESD) for esophageal recanalization is elegant and would be a good alternative to the double scope rendezvous technique.

However, we also noted some potential limitations to the ESD approach. First, high technical skills in ESD would be required for such intervention, and the procedure time will probably be much longer than the rendezvous approach, which was relatively quick in our study. Second, the feasibility remains questionable in cases of tortuous and long obstructions without possible transillumination, in cases of disappearance of the superior esophageal sphincter, or also in cases of obstruction due to etiologies other than radiation therapy (e. g. caustic, postoperative). Indeed, the authors acknowledge that they used the rendezvous technique in one of their four cases, for anatomic reasons. In our study, there was no limitation for achieving technical efficacy, with all locations and obstruction types being successfully treated by double scope anterograde – retrograde esophageal recanalization. Finally, it seems to us that there might be a risk of fibrotic and refractory re-stenosis because of the coagulation current applied, whereas in the rendezvous technique such current is not used.

In conclusion, we think that the ESD and rendezvous approaches should be compared in prospective studies, including long-term follow-up to compare intervals between repeated endoscopic dilations. Moreover, it is possible that, depending on the anatomic situation and the characteristics of the obstruction, the two techniques may be complementary, offering the best chance of recanalization to our patients.