Presented at the 112th Triological Society Combined Sections Meeting, Phoenix, Arizona, U.S.A.; May 29, 2009.
Head and Neck
Combined antegrade and retrograde esophageal dilation for head and neck cancer-related complete esophageal stenosis†
Article first published online: 8 DEC 2009
Copyright © 2009 The American Laryngological, Rhinological, and Otological Society, Inc.
Volume 120, Issue 2, pages 261–266, February 2010
How to Cite
Goguen, L. A., Norris, C. M., Jaklitsch, M. T., Sullivan, C. A., Posner, M. R., Haddad, R. I., Tishler, R. B., Burke, E. and Annino, D. J. (2010), Combined antegrade and retrograde esophageal dilation for head and neck cancer-related complete esophageal stenosis. The Laryngoscope, 120: 261–266. doi: 10.1002/lary.20727
- Issue published online: 20 JAN 2010
- Article first published online: 8 DEC 2009
- Manuscript Accepted: 19 AUG 2009
- Esophageal stenosis;
- pharyngo esophageal stenosis;
- head and neck cancer;
- antegrade esophageal dilation;
- retrograde esophageal dilation;
Assess the safety and efficacy of combined antegrade and retrograde esophageal dilation (CARD) for complete esophageal stenosis following head and neck cancer (HNC) treatment. Review HNC dysphagia management.
Retrospective review of all patients undergoing CARD following HNC treatment between May 2001 and September 2008.
Forty-five patients were identified for review. Parameters assessed included: ability to obtain intraoperative esophageal patency, complications, number of dilations required, diet, and gastric tube (GT) status. Factors associated with dilation failure were analyzed.
Intraoperative esophageal patency was obtained in 91% of patients. Median number of all dilations per patient was three. Median number of CARDs per patient was one. Resumption of oral intake occurred in 36/45 (80%). Diet results included: regular or soft diet 32/45 (71%), GT removal 27/45 (60%), and GT dependence with nothing by mouth 9/45 (20%). Laryngeal and pharyngeal stenosis, radionecrosis, tracheotomy dependence, and elongated stenosis were associated with dilation failure. Complications occurred in 18/63 (29%) CARD procedures: eight pneumomediastinum, seven GT site problems, two esophageal perforations, and one pharyngeal infection. All complications resolved spontaneously or with minimal interventions.
CARD was safe and effective. Intraoperative patency was achieved in 91% of patients. Eighty percent resumed oral intake. The majority of patients had their GTs removed and resumed a soft or regular diet. Dilation failure was associated with laryngeal, pharyngeal, and excessively long esophageal stenosis, often resulting from radionecrosis. Complications were minor. CARD should be considered before relegating patients with complete esophageal stenosis to chronic GT dependence or subjecting them to laryngopharyngo esophagectomy. Laryngoscope, 2010