Management of complete esophageal stricture after treatment of head and neck cancer using combined anterograde retrograde esophageal dilation

Fowlkes, Jonathan W; Zald, Philip B.; Andersen, Peter E.

doi:10.1002/hed.21826

Cited by 18 publications

(37 citation statements)

References 30 publications

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“…The included studies are summarized in Table . All studies were retrospective, and most reported outcomes of standard anterograde dilations using bougie or balloon dilators with or without guidewires.…”

Section: Resultsmentioning

confidence: 99%

“…All studies were retrospective, and most reported outcomes of standard anterograde dilations using bougie or balloon dilators with or without guidewires. Some studies reported outcomes of combined anterograde and retrograde dilation (CARD), a technique used in patients with total obstruction . The largest series reported outcomes in 111 patients (89 underwent anterograde dilation, 22 underwent CARD) .…”

Section: Resultsmentioning

confidence: 99%

“…The average patient age was 60 (range 21–89) years, and there was a near 3:1 male predominance (232:87, 73%:27%) . Cancer staging and treatment data were reported variably (Fig.…”

Section: Resultsmentioning

confidence: 99%

“…). Eleven studies reported primary tumor sites for a collective 318 patients: 46% oropharyngeal/hypopharyngeal, 27% laryngeal, 6% oral cavity, and 6% unknown primary . The remaining 15% comprised a collection of less common sites including the nasopharynx, thyroid, trachea, and cervical esophagus.…”

Section: Resultsmentioning

confidence: 99%

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Esophageal dilation in head and neck cancer patients: A systematic review and meta‐analysis

et al. 2017

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Objective: To characterize the safety profile and effectiveness of esophageal dilation in head and neck cancer patients. Methods: A systematic review was undertaken for articles reporting outcomes of esophageal dilation in head and neck cancer patients. The Medline, Scopus, Web of Science, and Cochrane databases were searched in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Complications related to esophageal dilation in head and neck cancer patients was the primary outcome of interest. Success rates, demographic data, cancer staging, and treatment data were assessed secondarily. Statistical analyses included both qualitative and quantitative assessments. A limited metaanalysis and pooling of the data was performed using a random effects model.Results: Of the collective 8,243 initial candidate articles, 15 retrospective studies containing data for a collective 449 patients were ultimately included in the analysis. There was significant heterogeneity in the outcomes data. With an overall complication rate of 10.6% (95% confidence interval [CI]: 4.1%,17%) and a pooled success rate of 72.9% (95% CI: 65.7%,80.1%) per patient, the articles generally supported the use of dilation.Conclusion: Head and neck cancer patients experience a higher rate of complications following dilation compared to patients with other causes of benign stricture. Esophageal dilation is effective in improving dysphagia, but these benefits are often transient and thus necessitate repeat interventions.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

“…The average patient age was 60 (range 21–89) years, and there was a near 3:1 male predominance (232:87, 73%:27%) . Cancer staging and treatment data were reported variably (Fig.…”

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

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Esophageal dilation in head and neck cancer patients: A systematic review and meta‐analysis

et al. 2017

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“…Despite attention to radiation‐induced stricture and its treatment, little is known about the long‐term effectiveness of dilation techniques on swallowing and patient satisfaction in high‐grade strictures. Presumably, the low incidence of high‐grade stricture has resulted in most treatment outcomes studies being relatively small (n ≤ 15), including case reports …”

Section: Discussionmentioning

confidence: 99%

Outcomes of serial dilation for high‐grade radiation‐related esophageal strictures in head and neck cancer patients

et al. 2014

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Objective Dysphagia and esophageal stricture are frequent consequences of treatment for head and neck cancer. This study examines the effectiveness of the anterograde-retrograde rendezvous procedure and serial dilations in re-establishing esophageal patency to allow return to oral diet and gastrostomy tube removal in a cohort of patients with complete or near-complete esophageal stricture following non-surgical cancer treatment. Study Design Retrospective review of patients treated with radiation therapy with or without concurrent chemotherapy presented with complete or near-complete esophageal stricture. Patients underwent serial dilations using combined anterograde-retrograde dilation (rendezvous) techniques. Methods Medical records of patients having undergone treatment between 2006 and 2012 were reviewed and semi-structured interviews were also conducted to determine current swallowing function and actual patient experience. The primary outcome was swallowing improvement that allowed for return to oral diet and/or gastrostomy tube removal. Outcomes were compared between patients with complete and near complete (<5 mm diameter) strictures and univariate analysis performed to identify associations between patient, cancer, and treatment characteristics on odds of gastrostomy tube removal. Results Twenty-four patients (Median age, 59.5 yrs; 63% male; 91% Caucasian) underwent treatment. 50% of patients had complete occlusion of the esophageal lumen. The majority (92%) patients underwent either anterograde (54%) or combined antero-retrograde (38%) approach. Following a median (IQR) 9 (6-20) dilation sessions, 42% of patients were able to return to an oral diet and/or had their gastrostomy tube removed. This outcome was independent of whether the stricture was complete or near complete (p=0.67). Of patients who had their gastrostomy tubes removed, only 33.3% had ever smoked, compared to 92.3% of those whose tubes were not discharged (p=0.007). Conclusions Recannulation is possible even in cases of complete or near-complete stricture. Several factors appear to impact the likelihood of successful outcome, but in this study, only patients with a history of smoking had a significantly lower likelihood of return to full oral diet.

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Success of endoscopic pharyngoesophageal dilation after head and neck cancer treatment

et al. 2013

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Objective To assess clinical success and safety of endoscopic pharyngoesophageal dilation after chemoradiation or radiation for head and neck cancer and to identify variables associated with dilation failure. Study Design Case series with chart review Methods Between 2000 and 2008 one hundred and eleven patients treated with chemoradiation or radiation for head and neck cancer with subsequent pharyngoesophageal stenosis requiring endoscopic dilation were identified. Patients were evaluated for endoscopic dilation technique, severity of stenosis, technical and clinical success and intra and post operative complications. The Diet/GT Score, range 1–5, was utilized to measure swallow success. Variables associated with dilation failure were analyzed by univariate and multivariate logistic regression. Results 271 dilations were analyzed, with 42 combined antegrade retrograde dilations, 208 dilations over a guidewire and 21 dilations without guidewire. Intraoperative patency and successful dilation of the stenotic segment was achieved in 95% of patients. A Diet/GT score of 5 (gastrostomy tube removed and soft/regular diet) was attained in 84/111 (76%) patients. Safety analysis showed complications occurred in 9% of all dilations. Perforations were noted in 4% of all procedures with only two esophageal perforations requiring significant intervention. Multiple dilations were associated with an increased risk for perforations. Further logistic regression analyses revealed that the number of dilations was indicating a poor outcome and low Diet/GT score. Conclusion Pharyngoesophageal stenosis, occurring after chemoradiation and radiation treatment, can be successfully and safely treated with endoscopic dilation techniques. Patients with restenosis, requiring multiple dilations, have a higher risk of persistent dysphagia. Level of Evidence 2b individual retrospective cohort study

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Management of complete esophageal stricture after treatment of head and neck cancer using combined anterograde retrograde esophageal dilation

Abstract: CARD offers benefit to most patients. Despite risks associated with the procedure, CARD should be considered by the clinician and patient in management of complete esophageal stricture.

Cited by 18 publications

References 30 publications

Esophageal dilation in head and neck cancer patients: A systematic review and meta‐analysis

Esophageal dilation in head and neck cancer patients: A systematic review and meta‐analysis

Outcomes of serial dilation for high‐grade radiation‐related esophageal strictures in head and neck cancer patients

Success of endoscopic pharyngoesophageal dilation after head and neck cancer treatment

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