Safety of Esophagoscopy in the Irradiated Esophagus

Abstract

Carcinoma of the esophagus is a disease with a poor prognosis. Surgery is considered the treatment of choice. Patients who are surgically unresectable may receive radiotherapy, plus or minus chemotherapy. While this offers reasonable palliation, a significant number of patients develop benign or malignant strictures. Frequent esophagoscopy with dilation is required if they are to swallow. Patients with strictures or malignancy of the esophagus are more prone to complications if they undergo an esophagoscopy. We examined the morbidity of esophagoscopy in a group of patients who had received radiotherapy for carcinoma of the esophagus. Over a 10-year period, 21 patients receiving irradiation for carcinoma of the esophagus were examined. All patients underwent esophagoscopy for staging and diagnosis. The tumor locations were upper (6), middle (6), and lower (9) esophagus. The T-stages were 1 (7), 2 (6), 3 (6), and 4 (2). Five patients had dilation of a malignant stricture at the time of diagnosis. Fever developed and resolved within 24 hours in 2 patients. Following completion of irradiation, a total of 83 esophagoscopies were performed (range 1 to 11 per patient). Six patients with no tumor or stricture underwent 8 esophagoscopies (3 rigid, 5 flexible). There was 1 episode of minimal bleeding and 1 fever that resolved within 24 hours. Ten patients with malignant strictures underwent 62 esophagoscopies (5 rigid, 57 flexible). There were 17 (27%) episodes of fever (all resolved within 24 hours) and 14 (22%) episodes of bleeding. Five patients with benign strictures underwent 13 esophagoscopies (2 rigid, 11 flexible). One patient had a perforation that resolved with conservative treatment, and 1 patient developed an epidural abscess 2 months following dilation. This patient is the only one that required surgical intervention and had prolonged hospitalization. Esophagoscopy of the irradiated esophagus can be performed relatively safely and excellent palliation obtained. Morbidity consisting of minimal bleeding, and fever lasting less than 24 hours, is frequent but self-limited.

Synovial sarcoma leading to a paraesophageal abscess in a child.

“…An upper gastrointestinal series three weeks after dilation did not reveal a fistula, suggesting that dilation was not causative. Previous studies have shown that esophageal dilation can be safely performed after radiotherapy [19,20], without increased risk of perforation [19]. …”

Spinal Epidural Abscess Presenting with Paraplegia Following Delayed Presentation of Traumatic Esophageal Perforation without Spinal Fracture: Lessons to be Learnt

“…Spinal epidural abscess is one such very rare but potentially catastrophic infective complication. A literature search identified only five case reports of spinal epidural abscess following esophageal perforation [2][3][4][5][6]. In these cases, the causes of esophageal perforation were iatrogenic esophageal instrumentation in three cases [2][3][4] and blunt trauma in association with spinal fracture in two cases [5,6].…”

“…Mediastinal sepsis progressing to spinal epidural abscess is an even rarer complication of esophageal perforation [2][3][4][5][6]. Both esophageal perforation and spinal epidural abscess require prompt treatment to avoid a disastrous outcome [7][8][9][10].…”