Anterograde insertion is difficult due to local infection

Problem: anterograde insertion is difficult due to local infection.
A good option in such a case is to use the traditional retrograde method, an example of which is shown to the right) which always ensures proper positioning of the esophageal flange. Although this latter procedure is seldom needed in daily practice, it should be kept in mind as a problem solver. Therefore, a separate disposable guide wire should always be at hand. In case of doubt about the correct position after anterograde replacement, either the retrograde technique should be used, or the anterograde technique should overshoot pulling back into the right position the prosthesis with one or two forceps.
A good option in such a case is to use the traditional retrograde method, an example of which is shown to the right) which always ensures proper positioning of the esophageal flange. Although this latter procedure is seldom needed in daily practice, it should be kept in mind as a problem solver. Therefore, a separate disposable guide wire should always be at hand. In case of doubt about the correct position after anterograde replacement, either the retrograde technique should be used, or the anterograde technique should overshoot pulling back into the right position the prosthesis with one or two forceps.