Endoscopic balloon dilatation for pharyngo-upper esophageal stricture after treatment of head and neck cancer
Endoscopic balloon dilatation for pharyngo-upper esophageal stricture after treatment of head and neck cancer
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DOI：
10.1111/den.12345
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发表时间：
2015-03-01
影响因子：
5.3
通讯作者：
Shimosegawa, Tooru
中科院分区：
文献类型：
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作者：
Maejima, Ryuhei;Iijima, Katsunori;Shimosegawa, Tooru
背景和目的：咽-食管上段狭窄引起的吞咽困难是头颈部恶性肿瘤治疗的并发症。内镜球囊扩张术（EBD）作为一种有效且安全的治疗胃肠道许多区域狭窄的方法被广泛使用。在本研究中，我们调查了EBD治疗头颈部癌症治疗后发生的咽-上食管狭窄的有效性和安全性。方法：从2010年1月至2013年12月，回顾性检查了19例头颈部癌症手术和/或放化疗后发生咽-上食管狭窄的连续患者的病历和内镜检查结果。结果：每例患者的平均EBD次数为6.6（1-30）次，平均最大扩张直径为15.8（11-20）mm。19例患者中有16例（84.2%）获得技术成功，在总共125次扩张中仅发生2例严重并发症（出血和咽水肿）（1.6%）。关于放化疗对EBD结局的影响，与仅接受手术的患者相比，接受放化疗加手术的患者在随访期间发生的再狭窄明显更多（50%vs0%，P < 0.05）。这项回顾性分析证明了EBD治疗咽部疾病的有效性和安全性。头颈部癌治疗后发生的食管上段狭窄，表明EBD的治疗应用可以扩展到此类狭窄。接受放化疗和手术的患者发生更多再狭窄;因此，此类患者应在EBD治疗后仔细随访。
Background and Aim: Dysphagia caused by pharyngo-upper esophageal stricture is a complication of treatment for head and neck cancer. Endoscopic balloon dilation (EBD) is in widespread use as an effective and safe treatment for stricture in many areas of the gastrointestinal tract. In the present study, we investigated the efficacy and safety of EBD for pharyngo-upper esophageal strictures that developed after treatment for head and neck cancer.Methods: From January 2010 to December 2013, the medical records and endoscopic findings of 19 consecutive patients with pharyngo-upper esophageal strictures occurring after surgery and/or chemoradiotherapy for head and neck cancer were retrospectively examined.Results: Mean number of EBD sessions per patient was 6.6 (1-30), and mean maximum diameter of dilation was 15.8 (11-20) mm. Technical success was achieved in 16 of 19 (84.2%) patients, and only two major complications (bleeding and pha-ryngeal edema) occurred in a total of 125 dilatation sessions (1.6%). Regarding the influence of chemoradiotherapy on the outcome of EBD, patients who had undergone chemoradiotherapy plus surgery experienced significantly more restenosis during the follow-up period compared to those who had undergone surgery alone (50% vs 0%, P < 0.05).Conclusions: This retrospective analysis demonstrated the efficacy and safety of exclusive EBD for pharyngo-upper esophageal strictures occurring after treatment for head and neck cancer, indicating that the therapeutic application of EBD could be extended to such strictures. Patients who underwent chemoradiotherapy and surgery experienced more restenosis; hence, such patients should be carefully followed up after EBD treatment.