Hostname: page-component-7479d7b7d-rvbq7 Total loading time: 0 Render date: 2024-07-14T11:50:16.288Z Has data issue: false hasContentIssue false

Anterograde–retrograde rendezvous approach for radiation-induced complete upper oesophageal sphincter stenosis: case report and literature review

Published online by Cambridge University Press:  19 May 2011

M P Kos*
Affiliation:
Department of Otolaryngology/Head and Neck Surgery, Free University Medical Center, Amsterdam, The Netherlands Department of Otolaryngology, Waterland Hospital, Purmerend, The Netherlands
E F David
Affiliation:
Department of Radiology, Free University Medical Center, Amsterdam, The Netherlands
H F Mahieu
Affiliation:
Department of Otolaryngology/Head and Neck Surgery, Meander Medical Center, Amersfoort, The Netherlands
*
Address for correspondence: Dr Martijn P Kos, Department of Otolaryngology, Waterland Hospital, PO Box 250, 1440 AG Purmerend, The Netherlands Fax: +31 299 457555 E-mail: martijn.kos@gmail.com

Abstract

Background:

Strictures of the hypopharynx and oesophagus are frequently observed following (chemo)radiation. Anterograde dilatation of a complete stenosis carries a high risk of perforation. An alternative is described: a combined anterograde–retrograde approach.

Case report:

A 75-year-old man developed complete stenosis of the oesophageal inlet after primary radiotherapy for laryngeal carcinoma and full percutaneous endoscopic gastrostomy feeding. To prevent creation of a false route into the mediastinum, a dilatation wire was introduced in a retrograde fashion into the oesophagus, through the gastrostomy opening. The wire was endoscopically identified from the proximal side and then passed through a perforation created by CO2 laser. Anterograde dilatation was safely performed, and the patient returned to a normal diet. There is consensus in the literature that blind anterograde dilatation carries a high risk of perforation; therefore, an anterograde–retrograde rendezvous technique is advisable.

Conclusion:

In cases of complete obstruction of the oesophageal inlet, anterograde–retrograde dilatation represents a safe technique with which to restore enteric continuity.

Type
Clinical Records
Copyright
Copyright © JLO (1984) Limited 2011

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1de Boer, MF, Pruyn, JF, van den Borne, B, Knegt, PP, Ryckman, RM, Verwoerd, CD. Rehabilitation outcomes of long-term survivors treated for head and neck cancer. Head Neck 1995;17:503–15CrossRefGoogle ScholarPubMed
2Laurell, G, Kraepelien, T, Mavroidis, P, Lind, BK, Fernberg, JO, Beckman, M et al. Stricture of the proximal esophagus in head and neck carcinoma patients after radiotherapy. Cancer 2003;97:1693–700CrossRefGoogle ScholarPubMed
3Lawson, JD, Otto, K, Grist, W, Johnstone, PA. Frequency of esophageal stenosis after simultaneous modulated accelerated radiation therapy and chemotherapy for head and neck cancer. Am J Otolaryngol 2008;29:1319CrossRefGoogle ScholarPubMed
4Guadagnolo, BA, Haddad, RI, Posner, MR, Weeks, L, Wirth, LJ, Norris, CM et al. Organ preservation and treatment toxicity with induction chemotherapy followed by radiation therapy or chemoradiation for advanced laryngeal cancer. Am J Clin Oncol 2005;28:371–8CrossRefGoogle ScholarPubMed
5Piotet, E, Escher, A, Monnier, P. Esophageal and pharyngeal strictures: report on 1,862 endoscopic dilatations using the Savary-Gilliard technique. Eur Arch Otorhinolaryngol 2008;265:357–64CrossRefGoogle Scholar
6van Twisk, JJ, Brummer, RJ, Manni, JJ. Retrograde approach to pharyngo-esophageal obstruction. Gastrointest Endosc 1998;48:296–9CrossRefGoogle ScholarPubMed
7Nguyen, NP, Sallah, S, Karlsson, U, Antoine, JE. Combined chemotherapy and radiation therapy for head and neck malignancies: quality of life issues. Cancer 2002;94:1131–41CrossRefGoogle ScholarPubMed
8Silvain, C, Barrioz, T, Besson, I, Babin, P, Fontanel, JP, Daban, A, Matuchansky, C, Beauchant, M. Treatment and long-term outcome of chronic radiation esophagitis after radiation therapy for head and neck tumors. A report of 13 cases. Dig Dis Sci 1993;38:927–31CrossRefGoogle ScholarPubMed
9Lee, WT, Akst, LM, Adelstein, DJ, Saxton, JP, Wood, BG, Strome, M et al. Risk factors for hypopharyngeal/upper esophageal stricture formation after concurrent chemoradiation. Head Neck 2006;28:808–12CrossRefGoogle ScholarPubMed
10Mekhail, TM, Adelstein, DJ, Rybicki, LA, Larto, MA, Saxton, JP, Lavertu, P. Enteral nutrition during the treatment of head and neck carcinoma: is a percutaneous endoscopic gastrostomy tube preferable to a nasogastric tube? Cancer 2001;91:1785–903.0.CO;2-1>CrossRefGoogle ScholarPubMed
11Eisbruch, A, Lyden, T, Bradford, CR, Dawson, LA, Haxer, MJ, Miller, AE et al. Objective assessment of swallowing dysfunction and aspiration after radiation concurrent with chemotherapy for head-and-neck cancer. Int J Radiat Oncol Biol Phys 2002;53:23–8CrossRefGoogle ScholarPubMed
12Petro, M, Wein, RO, Minocha, A. Treatment of a radiation-induced esophageal web with retrograde esophagoscopy and puncture. Am J Otolaryngol 2005;26:353–5CrossRefGoogle ScholarPubMed
13Maple, JT, Petersen, BT, Baron, TH, Kasperbauer, JL, Wong Kee Song, LM, Larson, MV. Endoscopic management of radiation-induced complete upper esophageal obstruction with an antegrade-retrograde rendezvous technique. Gastrointest Endosc 2006;64:822–8CrossRefGoogle ScholarPubMed
14Oxford, LE, Ducic, Y. Retrograde balloon dilation of complete cervical esophageal and hypopharyngeal strictures. J Otolaryngol 2006;35:327–31CrossRefGoogle ScholarPubMed