Dual Endoscopic Approach for Radiation-Induced Complete Esophageal Obstruction in the Upper Esophagus: Insights From 2 Challenging Cases.

Complete esophageal obstruction (CEO) is a rare complication of chemoradiotherapy for head and neck cancers. We report 2 cases of radiation-induced CEO in the upper esophagus, managed with combined antegrade and retrograde endoscopic dilatation (CARD). In 1 case, percutaneous endoscopic gastrostomy (PEG) dependence was eliminated, and swallowing was improved to a soft diet. In the second case, recurrence required repeat CARD, resulting in partial swallowing recovery but persistent PEG dependence. Both procedures were technically successful without major complications. These cases illustrate that CARD is a safe and effective alternative to surgery in CEO, even in technically challenging sites, enhancing quality of life, although recurrence remains a concern.