Gastrointestinal Endoscopy
Volume 71, Issue 7 , Pages 1122-1129, June 2010

Outcomes of a combined antegrade and retrograde approach for dilatation of radiation-induced esophageal strictures (with video)

Current affiliations: Center for Esophageal Diseases and Swallowing (E.D., N.C., R.M., I.G., N.S.), and Center for Gastrointestinal Biology and Disease (E.D., R.M., N.S.), Division of Gastroenterology and Hepatology, Department of Medicine; Department of Otolaryngology/Head and Neck Surgery (R.B., M.W., M.C.), University of North Carolina School of Medicine, Chapel Hill, North Carolina

Received 20 November 2009; accepted 23 December 2009. published online 26 April 2010.

Background

Treatment of head, neck, and esophageal cancers with radiation therapy can lead to esophageal strictures. In some cases, these can progress to complete esophageal obstruction, precluding typical antegrade endoscopic dilation.

Objective

The aim of this study was to review our experience with a combined antegrade/retrograde technique for dilation of complete esophageal strictures.

Design

Case series.

Setting

Tertiary-care referral center.

Patients

Twelve patients with complete esophageal radiation-induced strictures.

Interventions

In collaboration with otolaryngologists who performed direct antegrade esophagoscopy, retrograde endoscopy via gastrostomy was simultaneously performed. While visualizing the stricture from both sides and transilluminating, it was recannulated with use of a biliary or spring-tipped guidewire, and then dilated.

Main Outcome Measurements

Dilation method, complications, and postdilation oral intake.

Results

Combined antegrade and retrograde dilation was technically possible in 10 of the 12 patients (83%). Two cases were unsuccessful due to an inability to achieve transillumination. The only significant complication was a contained esophageal perforation that was managed nonoperatively. The mean number of repeat dilations was 7 (range, 1-22); none were complicated by perforation. Esophageal patency allowing at least some oral intake and tolerance of secretions was ultimately successful in 8 patients (67%).

Limitations

Retrospective, single center.

Conclusions

A combined antegrade/retrograde approach for dilation of complete esophageal radiation-induced strictures in collaboration with colleagues from otolaryngology is a viable treatment option. The procedure is technically feasible, effective, and well tolerated, although there may be an increased risk of esophageal perforation. This strategy may obviate a more invasive surgical approach.

Abbreviations: NGT, nasogastric tube, N/A, not available, G-tube, gastrostomy tube

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 DISCLOSURE: All authors disclosed no financial relationships relevant to this publication. (Research support for this study was provided in part by National Institutes of Health award no. KL2RR025746 from the National Center for Research Resources.)

 If you want to chat with an author of this article, you may contact Dr. Dellon at edellon@med.unc.edu.

PII: S0016-5107(10)00013-1

doi:10.1016/j.gie.2009.12.057

Gastrointestinal Endoscopy
Volume 71, Issue 7 , Pages 1122-1129, June 2010

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