Successful endoscopic recanalization of complete pharyngoesophageal obstruction after therapy of head and neck cancer

Abstract

Background Neopharyngeal obstruction after therapy of head and neck cancer is a frequent and clinically challenging problem without evidence-based guideline recommendations.

Case We present two cases of complete esophageal obstruction after treatment for head and neck cancer. Due to complete obstruction of long distance stricture standard dilatation procedures were impossible to perform. In both cases, recanalization was achieved by combining an antegrade with a retrograde maneuver. In one patient endoscopic cutting with a papillotome was needed.

Conclusion Even in complex cases of post-therapeutic stenosis an endoscopic approach may offer a feasible alternative to surgical therapy, especially in the subset of frail patients.

Zusammenfassung

Einleitung Posttherapeutische Stenosen sind für Patienten mit Malignomen im Hals-Nasen-Ohrenbereich eine häufige und schwer zu behandelnde Komplikation ohne klare Leitlinienempfehlungen.

Fall Uns gelang es bei zwei Patienten mit komplettem Verschluss die Kontinuität des (Neo-)Ösophagus wiederherzustellen mittels kombinierter antegrader und retrograder Endoskopie. In einem Fall war zur Gewebedestruktion der Einsatz eines Papillotoms notwendig.

Zusammenfassung Eine endoskopische Therapie ist somit auch bei vollständiger Stenose für diese Patienten eine Alternative zu einem chirurgischen Eingriff.

Key words

endoscopic recanalization - complete esophageal stenosis - dysphagia - head and neck cancer - interventional endoscopy - combined antegrade retrograde dilatation - CARD

Schlüsselwörter

Endoskopische Rekanalisation - komplette Ösophagusstenose - Dysphagie - Karzinom im Hals- und Kopfbereich - interventionelle Endoskopie - kombinierte Antegrade Retrograde Dilatation - CARD

• References

• 1 de Boer MF, Pruyn JF, van den Borne B. et al. Rehabilitation outcomes of long-term survivors treated for head and neck cancer. Head Neck 1995; 17: 503-515
• 2 Wang JJ, Goldsmith TA, Holman AS. et al. Pharyngoesophageal stricture after treatment for head and neck cancer. Head Neck 2012; 34: 967-973
• 3 Laurell G, Kraepelien T, Mavroidis P. et al. Stricture of the proximal esophagus in head and neck carcinoma patients after radiotherapy. Cancer 2003; 97: 1693-1700
• 4 Bueno R, Swanson SJ, Jaklitsch MT. et al. Combined antegrade and retrograde dilation, A new endoscopic technique in the management of complex esophageal obstruction. Gastrointest Endosc 2001; 54: 368-372
• 5 Gatta G, Botta L, Sánchez MJ. et al. Prognoses and improvement for head and neck cancers diagnosed in Europe in early 2000s, The EUROCARE-5 population-based study. Eur J Cancer 2015; 51: 2130-2143
• 6 van Twisk JJ, Brummer RJM, Manni JJ. Retrograde approach to pharyngo-esophageal obstruction. Gastrointest Endosc 1998; 48: 296-299
• 7 Baumgart DC, Veltzke-Schlieker W, Wiedenmann B. et al. Successful recanalization of a completely obliterated esophageal stricture by using an endoscopic rendezvous maneuver. Gastrointest Endosc 2005; 61: 473-475
• 8 Maple JT, Petersen BT, Baron TH. et al. Endoscopic management of radiation-induced complete upper esophageal obstruction with an antegrade-retrograde rendezvous technique. Gastrointest Endosc 2006; 64: 822-828
• 9 Lew RJ, Shah JN, Chalian A. et al. Technique of endoscopic retrograde puncture and dilatation of total esophageal stenosis in patients with radiation-induced strictures. Head Neck 2004; 26: 179-183
• 10 Fusco S, Kratt T, Gani C. et al. Rendezvous endoscopic recanalization for complete esophageal obstruction. Surg Endosc 2018; 32: 4256-4262