Road Map fluoroscopy successfully guides endoscopic interventions in the esophagus

Abstract

Background and study aims Road Map (RM) fluoroscopy is a radiological technique that enables visualization of anatomic structures using image subtraction at peak opacification. RM fluoroscopy has never previously been evaluated for use in endoscopy. The aim of this study was to evaluate the usefulness of RM in guiding endoscopic intervention in the esophagus. Patients and methods This was a monocentric observational trial of consecutive patients with esophageal strictures in a university hospital. Twenty-seven investigations using RM were performed in 24 patients undergoing esophageal endoscopy. Indications for the procedure were balloon dilatation (n = 7 including 2 pneumatic balloon dilatations for treatment of achalasia), bougie dilatation (n = 7) and diagnostic endoscopy (n = 1). In addition, 12 stents, 7 partially covered and 5 fully covered, were placed using RM as a guide for determination of stent length and diameter. Stents were deployed under RM guidance. Results In all procedures, RM successfully guided the intervention. Endoscopic control endoscopy confirmed adequate stent placement in all cases. The feeling of resistance during bougie dilation matched the RM-predicted location of the stenosis. With the help of RM imaging, dilatation balloons were easily centered inside the stenosis and thus slipping of the balloon was avoided. There were no adverse events. Conclusion RM allows permanent and accurate radiographic imaging of stenoses and esophageal anatomic changes. It is an easy and safe method of guiding endoscopic interventions that require radiological imaging.