Abstract
Background Endoscopic dilation of postlaryngectomy strictures (PLS) is safe and effective; however, PLS are often refractory and require serial dilations. Long-term outcomes of dilation in patients with refractory PLS are not well reported. Materials and Methods Seven patients with dysphagia and refractory PLS underwent serial endoscopic dilation therapy during a 4.5-year period. Dilation characteristics, technical success, clinical success, and diet advancement (as assessed by Diet/GT scale) were measured. Results. All strictures were complex, and there were no reported complications. The median number of dilations per patient was 12 (range 7 to 48). The average interval in between dilations was six weeks. Technical success was achieved in 6/7 patients, and clinical success was achieved in 2/7 patients. 6/7 patients had advancements in Diet/GT scores. Conclusions Dilation of refractory PLS is safe and effective and frequently requires the use of a retrograde approach, fluoroscopic guidance, and/or lumen patency strings. Serial dilations are required to maintain luminal patency, relieve dysphagia, and advance oral diet. The definition of clinical success of dilation in these patients should avoid the use of a specific time interval between dilations to characterize success.
Highlights
Dysphagia and pharyngoesophageal strictures are frequent complications associated with treatment for head and neck cancer and can negatively affect quality of life and lead to social isolation [1]
Laryngectomy, radiation (in a dosevolume relationship, in particular intensity-modulated radiation therapy (IMRT)), radiation in combination with chemotherapy, and chemoradiotherapy plus surgery have all been shown to lead to pharyngoesophageal stricture formation [1,2,3,4,5,6]
Of the 6 patients who had tracheoesophageal voice prosthesis (TEP) placed, TEP displacement during dilation occurred in only 2 patients a total of 4 times out of 106 dilations
Summary
Dysphagia and pharyngoesophageal strictures are frequent complications associated with treatment for head and neck cancer and can negatively affect quality of life and lead to social isolation [1]. Stricture formation may be due to collagen deposition and fibrin production from deep ulceration or chronic inflammation In this setting, recurrent and/or refractory anastomotic strictures result from cicatricial luminal compromise or fibrosis in the absence of inflammation on endoscopy [9, 10]. Endoscopic dilation of postlaryngectomy strictures (PLS) is safe and effective; PLS are often refractory and require serial dilations. Long-term outcomes of dilation in patients with refractory PLS are not well reported. Seven patients with dysphagia and refractory PLS underwent serial endoscopic dilation therapy during a 4.5-year period. Dilation of refractory PLS is safe and effective and frequently requires the use of a retrograde approach, fluoroscopic guidance, and/or lumen patency strings. Serial dilations are required to maintain luminal patency, relieve dysphagia, and advance oral diet. The definition of clinical success of dilation in these patients should avoid the use of a specific time interval between dilations to characterize success
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