Extreme Endoscopy: The Double-Scope Rescue for Esophageal Perforation

Extreme Endoscopy: The Double-Scope Rescue

A patient arrives after esophageal stent placement gone wrong. The stent has migrated across the esophagogastric junction into the pleura. There is a large perforation, sepsis, open surgery, and now a complete anastomotic dehiscence. Upper endoscopy confirms the guidewire is entering the abdominal cavity. Standard wire placement is not possible. What do you do next?

When standard access fails: a simultaneous oral and gastrostomy approach

A metal stent placed for esophageal cancer had migrated across the esophagogastric junction into the pleura and peritoneum, causing a large perforation. The patient developed sepsis and underwent open surgery, but the surgeons could only place drains and a gastrostomy tube to feed the patient. The connection between the esophagus and stomach remained completely disrupted.

In this 3-minute clip from the “Extreme Endoscopy” lecture, Dr. Klaus Monkemuller demonstrates the simultaneous double-scope technique: a standard gastroscope passed through the mouth and an ultra-thin transnasal gastroscope passed through the surgical gastrostomy site. Together, the two scopes allowed the team to visualize the gastric lumen, guide wire placement, and deploy two fully covered metal stents to reconnect the esophagus and stomach.