Ahlawat Sushil K, Al-Kawas Firas H
Division of Gastroenterology and Hepatology, University of Medicine and Dentistry New Jersey-New Jersey Medical School, Newark, New Jersey, USA.
Gastrointest Endosc. 2008 Jul;68(1):19-24. doi: 10.1016/j.gie.2007.11.027. Epub 2008 Mar 19.
Dysphagia, usually due to proximal esophageal strictures, is a debilitating complication of therapy (surgery, radiotherapy, or chemotherapy) for head and neck malignancy. Scant attention has been given in the literature to the endoscopic management of these proximal esophageal strictures.
Our purpose was to assess the technical and functional outcomes of endoscopic management of proximal esophageal strictures after therapy for head and neck cancers.
Retrospective case series.
Academic medical center.
Consecutive patients undergoing endoscopy and dilation of proximal esophageal strictures caused by chemoradiation or surgery for head and neck malignancy.
Technical and functional success after endoscopic dilation.
Twenty-four patients were included. The mean age of patients was 70.4 years (range 42 to 82 years). The primary tumor site was larynx in 10 patients, oropharynx or hypopharynx in 4 patients, upper esophagus in 4 patients, and other sites in the remainder. Technical success (a luminal diameter of 42F or greater) was achieved in 80% of patients. Adequate dysphagia relief was achieved in 84% of patients whose esophageal stricture was dilated at least up to 42F. The average follow-up was 22 months (range 1-96 months). Repeat dilation was needed in 58% of patients. No complications or death occurred during the study period.
Retrospective design and highly selected patient population. Dysphagia assessment in conjuction with a speech pathologist was not performed in all patients. Results may not be applicable to other settings.
In this case series, proximal esophageal strictures after treatment of head and neck malignancy were amenable to antegrade endoscopic dilation; however, no patient in our study had complete lumen obstruction. Repeat dilations are often needed and are effective in achieving and maintaining adequate dysphagia relief.
吞咽困难通常由近端食管狭窄引起，是头颈部恶性肿瘤治疗（手术、放疗或化疗）的一种使人衰弱的并发症。文献中对这些近端食管狭窄的内镜治疗关注甚少。
我们的目的是评估头颈部癌症治疗后近端食管狭窄的内镜治疗的技术和功能结果。
回顾性病例系列。
学术医疗中心。
因头颈部恶性肿瘤接受放化疗或手术导致近端食管狭窄并接受内镜检查和扩张的连续患者。
内镜扩张后的技术和功能成功情况。
纳入24例患者。患者的平均年龄为70.4岁（范围42至82岁）。原发肿瘤部位为喉部10例，口咽或下咽4例，食管上段4例，其余为其他部位。80%的患者取得技术成功（管腔直径达到42F或更大）。食管狭窄至少扩张至42F的患者中，84%的患者吞咽困难得到充分缓解。平均随访22个月（范围1 - 96个月）。58%的患者需要重复扩张。研究期间未发生并发症或死亡。
回顾性设计和高度选择的患者群体。并非所有患者都联合言语病理学家进行吞咽困难评估。结果可能不适用于其他情况。
在这个病例系列中，头颈部恶性肿瘤治疗后的近端食管狭窄适合顺行内镜扩张；然而，我们研究中没有患者存在完全管腔梗阻。通常需要重复扩张，且在实现和维持充分缓解吞咽困难方面有效。
