Division of Gastroenterology, University of Colorado, Denver, Colorado, USA.
University of Florida, Gainesville, Florida, USA.
Gastrointest Endosc. 2017 Apr;85(4):722-727. doi: 10.1016/j.gie.2016.08.035. Epub 2016 Sep 7.
Total aphagia from complete esophageal obstruction (CEO) can be seen in patients with head-neck or thoracic malignancies undergoing chemoradiation or surgery. Combined antegrade and retrograde endoscopy (via gastrostomy tube [G-tube] tract) is often performed for esophageal reconstruction but is limited by the length of the obstructed esophagus. We describe per-oral endoscopic tunneling for restoration of the esophagus (POETRE) for patients with longer segments of esophageal obstruction. The aim of this study was to assess the efficacy and safety of POETRE for CEO.
All patients with CEO undergoing endoscopy with POETRE from October 2013 to September 2015 were enrolled in this single-center prospective study. Clinical, endoscopic, and radiologic records were maintained as required for clinical care and for the study. Dysphagia score was recorded before and after POETRE. Adverse events were assessed based on the American Society for Gastrointestinal Endoscopy criteria.
Four patients (3 men; mean age, 72.3 years) underwent POETRE for CEO ≥3 cm in length. Esophageal reconstruction was technically successful in all patients (100%). Antegrade submucosal tunneling was performed in 2 of 4 patients (50%), and retrograde tunneling was performed in the other 2 patients, all with simultaneous dual endoscope and fluoroscopic guidance. The mean dysphagia score of 4 before the procedure improved to 2.5 after POETRE during follow-up (mean, 27.8 weeks). All patients required subsequent serial endoscopic dilations as needed after POETRE. One adverse event (pneumonia) was seen (25%).
We present a novel ESD technique, POETRE, for therapy of complete esophageal obstruction. This approach is specifically useful for lumen restoration in patients with longer segments of esophageal obstruction. (Clinical trial registration number: NCT00968552.).
头颈部或胸部恶性肿瘤患者在接受放化疗或手术治疗时，可能会出现完全性食管梗阻（CEO）导致的完全禁食。为了进行食管重建，通常会联合使用经皮内镜胃造瘘术（G 管）进行顺行和逆行内镜检查，但这种方法受到梗阻食管长度的限制。我们描述了一种用于治疗更长段食管梗阻的经口内镜下隧道技术（POETRE）。本研究旨在评估 POETRE 治疗 CEO 的疗效和安全性。
所有因 CEO 而行内镜下 POETRE 的患者均于 2013 年 10 月至 2015 年 9 月期间入组本单中心前瞻性研究。为了临床护理和研究需要，记录了患者的临床、内镜和影像学资料。记录 POETRE 前后的吞咽困难评分。根据美国胃肠内镜学会标准评估不良事件。
4 例（3 例男性；平均年龄 72.3 岁）患者因 CEO 长度≥3cm 而行 POETRE。所有患者（100%）均成功完成了食管重建。4 例患者中有 2 例（50%）行顺行黏膜下隧道，另外 2 例患者行逆行隧道，均同时行双内镜和透视引导。术前的平均吞咽困难评分为 4 分，POETRE 后随访时改善至 2.5 分（平均随访时间 27.8 周）。所有患者在 POETRE 后均需要根据需要进行多次内镜扩张。1 例（25%）出现不良事件（肺炎）。
我们提出了一种治疗完全性食管梗阻的新型 ESD 技术 POETRE。这种方法特别适用于食管梗阻较长段的患者的管腔重建。（临床试验注册号：NCT00968552.）
