Section of Otolaryngology Head and Neck Surgery, Department of Surgery, University of Chicago Medical Center and Pritzker School of Medicine, Chicago, IL 60637, USA.
J Gastrointest Surg. 2010 Jul;14(7):1186-9. doi: 10.1007/s11605-010-1205-z. Epub 2010 May 4.
Esophageal stricture is a well-known complication of chemoradiotherapy for head and neck malignancies. These strictures almost exclusively occur in the cervical esophagus within the field of radiation. For some patients, identification of the esophageal lumen for antegrade dilation of these strictures can be a challenge, and creation of a false lumen can occur during attempts at dilation.
We report a method of identifying the esophageal lumen using retrograde esophagoscopy through an existing gastrostomy, thereby allowing confident dilation of an esophageal stricture.
The esophagoscope is used to pass a guide wire from below the stricture, and this guide wire is used for bougie dilation of the stricture. Following retrograde dilation, we often place a modified feeding tube to preserve the lumen for future dilation attempts.
This method can be used to safely place a guide wire for dilation in patients who have a difficult cervical esophageal stricture and an established gastrostomy.
食管狭窄是头颈部恶性肿瘤放化疗后的一种常见并发症。这些狭窄几乎只发生在放射野内的颈段食管。对于一些患者来说，为这些狭窄进行顺行扩张时，确认食管管腔可能具有挑战性，并且在扩张过程中可能会形成假腔。
我们报告了一种通过现有的胃造口术进行逆行食管镜检查来识别食管管腔的方法，从而可以对食管狭窄进行有信心的扩张。
使用食管镜将导丝从狭窄下方穿过，并用该导丝对狭窄进行探条扩张。逆行扩张后，我们通常会放置改良的喂养管以保留管腔，以备将来进行扩张尝试。
对于存在难以处理的颈段食管狭窄和已建立的胃造口术的患者，此方法可用于安全地放置用于扩张的导丝。
