Hayat Umar, Khan Yakub I, Deivert Duane, Obuch Joshua, Altaf Athar, Boger John, Kamal Faisal, Diehl David L
Department of Internal Medicine, Geisinger Wyoming Valley Medical Center, Wilkes-Barre, United States.
Department of Internal Medicine, Division of Gastroenterology, Geisinger Wyoming Valley Medical Center, Wilkes-Barre, United States.
Endosc Int Open. 2024 Oct 15;12(10):E1199-E1205. doi: 10.1055/a-2422-8792. eCollection 2024 Oct.
Complete esophageal obstruction (CEO) is a rare complication of radiation therapy for esophageal or head and neck cancers and can be challenging to manage endoscopically. A rendezvous approach by combined anterograde and retrograde endoscopic dilation (CARD) can be used to re-establish luminal integrity in such cases. Our study aimed to review our experience with patients with CEOs managed by CARD. Six patients who had CARD for CEO were reviewed. The primary outcomes were immediate technical and clinical success of CARD. Secondary outcomes were adverse events (AEs) associated with the procedure and continued dependency on the percutaneous endoscopic gastrostomy (PEG)-or jejunostomy tube. The mean age was 59 years (range 38-83). Five patients had CEO secondary to neoadjuvant chemoradiotherapy for esophageal cancer, and one patient had complete obstruction secondary to neck trauma. CARD was technically successful in five patients (86%). Two patients had AEs. One had pneumomediastinum requiring no intervention, while the other had bilateral pneumothorax requiring chest tube placement. The median follow-up duration of repeated dilations to maintain liminal patency was 20 months. Four patients had improvement in dysphagia, tolerating oral intake, and mouth secretions after the procedure, with a mean functional oral intake scale (FOIS) score > 3 and an overall success rate of 83%. The CARD approach to re-establish esophageal luminal patency in CEO is a safer alternative to high-risk blind antegrade dilation or an invasive surgical approach. It is usually technically feasible with improved swallowing ability in most patients.
完全性食管梗阻（CEO）是食管癌或头颈癌放射治疗的一种罕见并发症，在内镜下处理具有挑战性。对于此类病例，可采用顺行和逆行内镜联合扩张的会师方法（CARD）来重建管腔完整性。我们的研究旨在回顾我们使用CARD治疗CEO患者的经验。对6例接受CARD治疗CEO的患者进行了回顾。主要结局是CARD的即刻技术和临床成功率。次要结局是与该操作相关的不良事件（AE）以及对经皮内镜下胃造口术（PEG）或空肠造口管的持续依赖。平均年龄为59岁（范围38 - 83岁）。5例患者因食管癌新辅助放化疗继发CEO，1例患者因颈部创伤继发完全性梗阻。CARD在5例患者（86%）中技术成功。2例患者发生AE。1例发生纵隔气肿，无需干预，另1例发生双侧气胸，需要放置胸管。为维持管腔通畅而进行反复扩张的中位随访时间为20个月。4例患者术后吞咽困难、经口进食和口腔分泌物情况改善，平均功能性经口进食量表（FOIS）评分>3，总体成功率为83%。在CEO中重建食管管腔通畅的CARD方法是高风险盲法顺行扩张或侵入性手术方法的更安全替代方案。在大多数患者中，它通常在技术上可行，且吞咽能力有所改善。
