Mavrogenis Georgios, MD, from the Department of Gastroenterology at the Grand Hôpital de Charleroi in Charleroi, Belgium presents this video demonstration of a rendezvous technique for the treatment of malignant esophagorespiratory fistula.

This video case demonstrates the rendezvous technique in 2 difficult cases of complex esophageal stenosis with multiple fistulae. The rendezvous technique needs the coordination of 2 endoscopists in order to reestablish the esophageal pathway. Various and copious techniques with a lot of  imagination are necessary in order to identify the way among the several orifices that may be encountered due to the altered anatomy. The 2 procedures that are demonstrated in 6 minutes lasted several hours.

We would like to mention 2 techniques that we found useful in the management of these cases. Firstly, switching off the light source of 1 endoscope may help identify the right direction with the help of the light coming from the other endoscope. Secondly, trying to pass the guidewire from both directions may be useful.

I would like to thank, Dr. Coumaros for  teaching me the principles of therapeutic endoscopy during my training in Strasbourg.

Read the full article and find more cases from VideoGIE online.