Case study
Functional outcome of patients treated for radiation-induced complete esophageal obstruction after successful endoscopic recanalization (with video)

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Patients and study design

A retrospective chart review was performed to identify patients with radiation-induced complete esophageal obstruction treated endoscopically between August 2001 and February 2013 at Mayo Clinic, Rochester, Minnesota. Patients treated with flexible endoscopy with dilation were identified. Procedures were performed by gastroenterologists with or without otolaryngologist assistance. Data extracted included demographic characteristics, clinical features, cancer treatment, endoscopic therapy,

Results

Forty-four patients with complete esophageal obstruction were identified. Nine patients, all with an obstruction >3 cm in length failed endoscopic recanalization and were excluded from analysis. Clinical characteristics of the 35 patients are listed in Table 1. Most patients had stage IV disease, with the oropharynx and larynx being the most common primary cancers. Only 6 patients did not receive concurrent chemotherapy. In 8 patients in whom the radiation dose was known, the total dose

Discussion

We found a moderate rate of successful functional outcome in patients with radiation-induced total esophageal obstruction despite successful endoscopic recanalization. Long-term, 11 of 25 patients (44%) were able to eat at least soft foods. Although 6 patients were dysphagia-free, ongoing dilation was needed in 3 patients. Gastrostomy tube removal was possible in only 8 patients (23%), and the majority (14/25 patients, 56%) were not able to swallow adequately even after dilation to >12.8 mm,

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DISCLOSURE: T. Baron is a consultant for W.L. Gore. All other authors disclosed no financial relationships relevant to this publication.

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