Fig. 6. (A) Contrast injection during stent insertion: The top markers of the initial EGIS esophageal stent (S&G Biotech; white arrowheads) are seen below the stricture. The top of the stricture is at C7 (black arrow), one vertebral body below the impression of cricopharyngeus (CPS; black arrowhead). White arrow, Ultraflex tracheal stent (Boston Scientific, St. Albans, UK). (B) The tip of the delivery system (arrow) has been advanced retrogradely through the gastrostomy past the upper end of the first stent (arrowheads) into the oropharynx. (C) The distal end of the stent has been released in the pharynx. Black arrowheads, stent markers; black arrow, ring marker on the constraining sheath at the level of CPS. A 6F catheter has been inserted from the mouth to allow outlining of the anatomy with contrast (white arrowhead). (D) The part-deployed is withdrawn until the distal markers (arrowheads) lie at C7. Arrow, ring marker on constraining sheath. (E) Final result: Limited initial expansion across the stricture at the top of the tracheal stent (arrowheads), but with a good flare of the stent head above it.
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