Innere Medizin I, Universitätsklinikum Tübingen, Otfried-Müller-Str. 10, 72076, Tübingen, Germany.
Department of Internal Medicine, Spital am Limmat, Schlieren, Switzerland.
Surg Endosc. 2018 Oct;32(10):4256-4262. doi: 10.1007/s00464-018-6174-4. Epub 2018 Mar 30.
Complete esophageal obstruction after (chemo)radiation for head and neck cancers is rare. However, inability to swallow one's own saliva strongly inflicts upon quality of life. Techniques for endoscopic recanalization in complete obstruction are not well established. We assessed the efficacy and safety of rendezvous recanalization.
We performed a retrospective review of all patients who underwent endoscopic recanalization of complete proximal esophageal obstruction after radiotherapy between January 2009 and June 2016. Technical success was defined as an ability to pass an endoscope across the recanalized lumen, clinical success by changes in the dysphagia score. Adverse events were recorded prospectively.
19 patients with complete obstruction (dysphagia IV°), all of whom had failed at least one trial of conventional dilatation, underwent recanalization by endoscopic rendezvous, a combined approach through a gastrostomy and perorally under fluoroscopic control. Conscious sedation was used in all patients. In 18/19 patients (94.7%), recanalization was technically successful. In 14/18 patients (77.8%), the post-intervention dysphagia score changed to ≤ II. Three patients had their PEG removed. Factors negatively associated with success were obstruction length of 50 mm; and tumor recurrence for long-term success. No severe complications were recorded.
Rendezvous recanalization for complete esophageal obstruction is a reliable and safe method to re-establish luminal patency. Differences between technical and clinical success rates highlight the importance of additional functional factors associated with dysphagia. Given the lack of therapeutic alternatives, rendezvous recanalization is a valid option to improve dysphagia.
头颈部癌症放化疗后完全性食管梗阻较为罕见，但不能吞咽自身唾液会严重影响生活质量。对于完全性梗阻的内镜再通技术尚未完全确立。我们评估了会师再通术的疗效和安全性。
我们对 2009 年 1 月至 2016 年 6 月期间因放疗后完全性近端食管梗阻而行内镜再通治疗的所有患者进行了回顾性研究。技术成功定义为内镜能够通过再通的管腔，临床成功定义为吞咽困难评分的变化。前瞻性记录不良事件。
19 例完全性梗阻患者（吞咽困难Ⅳ度），所有患者均至少尝试过一次常规扩张治疗失败，通过内镜会师技术（经皮胃造口和口内透视引导的联合方法）进行再通。所有患者均接受了镇静。19 例患者中（94.7%），18 例（94.7%）再通技术成功。14 例（77.8%）患者术后吞咽困难评分降至≤Ⅱ级。3 例患者的 PEG 被移除。与成功相关的负性因素包括梗阻长度为 50mm；和肿瘤复发的长期成功率。未记录到严重并发症。
会师再通术是一种可靠且安全的方法，可重新建立管腔通畅性。技术成功率和临床成功率之间的差异突出了与吞咽困难相关的其他功能因素的重要性。鉴于缺乏治疗选择，会师再通术是改善吞咽困难的有效选择。
