Outcomes of a combined antegrade and retrograde approach for dilatation of radiation-induced esophageal strictures (with video)

BackgroundTreatment of head, neck, and esophageal cancers with radiation therapy can lead to esophageal strictures. In some cases, these can progress to complete esophageal obstruction, precluding typical antegrade endoscopic dilation.ObjectiveThe aim of this study was to review our experience with a combined antegrade/retrograde technique for dilation of complete esophageal strictures.DesignCase series.SettingTertiary-care referral center.PatientsTwelve patients with complete esophageal radiation-induced strictures.InterventionsIn collaboration with otolaryngologists who performed direct antegrade esophagoscopy, retrograde endoscopy via gastrostomy was simultaneously performed. While visualizing the stricture from both sides and transilluminating, it was recannulated with use of a biliary or spring-tipped guidewire, and then dilated.Main Outcome MeasurementsDilation method, complications, and postdilation oral intake.ResultsCombined antegrade and retrograde dilation was technically possible in 10 of the 12 patients (83%). Two cases were unsuccessful due to an inability to achieve transillumination. The only significant complication was a contained esophageal perforation that was managed nonoperatively. The mean number of repeat dilations was 7 (range, 1-22); none were complicated by perforation. Esophageal patency allowing at least some oral intake and tolerance of secretions was ultimately successful in 8 patients (67%).LimitationsRetrospective, single center.ConclusionsA combined antegrade/retrograde approach for dilation of complete esophageal radiation-induced strictures in collaboration with colleagues from otolaryngology is a viable treatment option. The procedure is technically feasible, effective, and well tolerated, although there may be an increased risk of esophageal perforation. This strategy may obviate a more invasive surgical approach.