Howell Rebecca J, Schopper Melissa A, Giliberto John Paul, Collar Ryan M, Khosla Sid M
Department of Otolaryngology-Head and Neck Surgery, University of Cincinnati College of Medicine, Cincinnati, Ohio, U.S.A.
Laryngoscope. 2018 Oct;128(10):2261-2267. doi: 10.1002/lary.27121. Epub 2018 Feb 8.
To review experience, safety, and cost of office-based esophageal dilation in patients with history of head and neck cancer (HNCA).
The medical records of patients undergoing esophageal dilation in the office were retrospectively reviewed between August 2015 and May 2017. Patients were given nasal topical anesthesia. Next, a transnasal esophagoscopy (TNE) was performed. If the patient tolerated TNE, we proceeded with esophageal dilation using Seldinger technique with the CRE™ Boston Scientific (Boston Scientific Corp., Marlborough, MA) balloon system. Patients were discharged directly from the outpatient clinic.
Forty-seven dilations were performed in 22 patients with an average of 2.1 dilations/patient (range 1-10, standard deviation [SD] ± 2.2). Seventeen patients (77%) were male. The average age was 67 years (range 35-78 years, SD ± 8.5). The most common primary site of cancer was oral cavity/oropharynx (n = 10), followed by larynx (n = 6). All patients (100%) had history of radiation treatment. Four patients were postlaryngectomy. The indication for esophageal dilation was esophageal stricture and progressive dysphagia. All dilations occurred in the proximal esophagus. There were no major complications. Three focal, superficial lacerations occurred. Two patients experienced mild, self-limited epistaxis. One dilation was poorly tolerated due to discomfort. One patient required pain medication postprocedure. Office-based esophageal dilation generated $15,000 less in health system charges compared to traditional operating room dilation on average per episode of care.
In patients with history of HNCA and radiation, office-based TNE with esophageal dilation appears safe, well-tolerated, and cost-effective. In a small cohort, the technique has low complication rate and is feasible in an otolaryngology outpatient office setting.
回顾有头颈癌（HNCA）病史患者在门诊进行食管扩张术的经验、安全性及费用。
回顾性分析2015年8月至2017年5月在门诊接受食管扩张术患者的病历。患者接受鼻腔局部麻醉。接下来，进行经鼻食管镜检查（TNE）。如果患者能耐受TNE，我们采用波士顿科学公司（位于马萨诸塞州马尔伯勒市）的CRE™球囊系统，通过Seldinger技术进行食管扩张。患者直接从门诊出院。
22例患者共进行了47次扩张，平均每位患者2.1次（范围1 - 10次，标准差[SD]±2.2）。17例（77%）患者为男性。平均年龄67岁（范围35 - 78岁，SD±8.5）。最常见的癌症原发部位是口腔/口咽（n = 10），其次是喉（n = 6）。所有患者（100%）都有放疗史。4例患者行喉切除术后。食管扩张的指征是食管狭窄和进行性吞咽困难。所有扩张均发生在食管近端。无重大并发症。发生了3处局灶性浅表撕裂伤。2例患者出现轻度、自限性鼻出血。1次扩张因不适耐受性差。1例患者术后需要止痛药物。与传统手术室扩张相比，门诊食管扩张每次护理平均产生的卫生系统费用少15,000美元。
对于有HNCA病史和放疗史的患者，门诊TNE联合食管扩张术似乎安全、耐受性良好且具有成本效益。在一个小队列中，该技术并发症发生率低，在耳鼻喉科门诊环境中可行。
4。《喉镜》，128:2261 - 2267，2018年。
