Joy McCann Culverhouse Center for Swallowing Disorders, Department of Internal Medicine, University of South Florida College of Medicine, Tampa, Florida 33612, USA.
Gastrointest Endosc. 2012 Jul;76(1):25-31. doi: 10.1016/j.gie.2012.02.037. Epub 2012 Apr 5.
After chemoradiation therapy for head/neck cancer, some patients develop strictures that progress to complete pharyngoesophageal occlusion. Total lumen occlusion is less often due to other conditions. Enteral access (enterostomy tube) and good nutritional status tend to minimize the significance of dysphagia and therefore may mask recognition of impending complete lumen occlusion.
Review outcomes of a 25-year experience with endoscopic lumen restoration (ELR) in 30 patients.
Retrospective, case review study.
Two tertiary-care referral centers.
This study involved 30 consecutive patients referred for obstructive aphagia due to complete lumen occlusion, primarily after chemoradiation therapy for head/neck cancer.
Antegrade and retrograde endoscopy with tri-plane fluoroscopy for penetrating the occluded segment, serial retrograde and antegrade dilations, plus swallowing rehabilitation therapy.
Restoration of lumen patency, swallowing function, and removal of enteral feeding tube.
ELR was successful in 30 patients in 31 of 33 attempts (93%). Return to soft to regular diet was achieved in 15 of 30 patients (50%), and fluids to pureed food with partial percutaneous endoscopic gastrostomy nutrition was achieved in 5 of 30 patients (17%). Ten of 30 patients (33%) were considered unsafe for oral feeding because of oropharyngeal neuromotor deficits. Complications occurred in 5 of 30 patients (17%), with no prolonged sequelae, deaths, or surgery, but two stents were placed for anastomotic fistulas. The median duration of follow-up was 22.75 months.
Retrospective, case review study.
ELR by using tri-plane fluoroscopic guidance with antegrade and retrograde endoscopy and serial dilations allows lumen restoration and swallowing to some degree in a majority of patients. Engagement of a core team of specialists can provide optimal restoration of swallowing function.
头颈部癌症放化疗后，部分患者会出现进展为完全咽食管闭塞的狭窄。完全管腔闭塞则较少由其他原因引起。肠内通路（肠造口管）和良好的营养状况往往会最小化吞咽困难的意义，因此可能会掩盖即将发生完全管腔闭塞的识别。
回顾 30 例 25 年内镜管腔重建（ELR）经验的结果。
回顾性病例研究。
两个三级转诊中心。
本研究纳入了 30 例因完全管腔闭塞导致阻塞性吞咽困难而连续就诊的患者，主要是头颈部癌症放化疗后。
经前向和后向内镜检查，三平面透视以穿透闭塞段，进行系列的后向和前向扩张，并结合吞咽康复治疗。
管腔通畅性、吞咽功能恢复和肠内喂养管的去除。
33 次尝试中有 30 例患者（93%）在 31 次尝试中成功进行了 ELR。30 例患者中有 15 例（50%）恢复了软食至常规饮食，5 例（17%）可进流食至泥状食物，并辅以部分经皮内镜胃造瘘营养。30 例患者中有 10 例（33%）由于口咽运动神经缺损而被认为不适合经口喂养。30 例患者中有 5 例（17%）发生并发症，无长期后遗症、死亡或手术，但有 2 例患者因吻合口瘘而放置支架。中位随访时间为 22.75 个月。
回顾性、病例回顾研究。
采用三平面透视引导的前向和后向内镜检查以及系列扩张术进行 ELR，可以在大多数患者中在一定程度上恢复管腔通畅和吞咽功能。核心专家团队的参与可以提供最佳的吞咽功能恢复。
