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Norton BC, Papaefthymiou A, Aslam N, Telese A, Murray C, Murino A, Johnson G, Haidry R. The endoscopic management of oesophageal strictures. Best Pract Res Clin Gastroenterol 2024; 69:101899. [PMID: 38749578 DOI: 10.1016/j.bpg.2024.101899] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Revised: 02/04/2024] [Accepted: 02/25/2024] [Indexed: 05/26/2024]
Abstract
An oesophageal stricture refers to a narrowing of the oesophageal lumen, which may be benign or malignant. The cardinal feature is dysphagia, and this may result from intrinsic oesophageal disease or extrinsic compression. Oesophageal strictures can be further classified as simple or complex depending on stricture length, location, diameter, and underlying aetiology. Many endoscopic options are now available for treating oesophageal strictures including dilatation, injectional therapy, stenting, stricturotomy, and ablation. Self-expanding metal stents have revolutionised the palliation of malignant dysphagia, but oesophageal dilatation with balloon or bougienage remains first-line therapy for most benign strictures. The increase in endoscopic and surgical interventions on the oesophagus has seen more benign refractory oesophageal strictures that are difficult to treat, and often require advanced endoscopic techniques. In this review, we provide a practical overview on the evidence-based management of both benign and malignant oesophageal strictures, including a practical algorithm for managing benign refractory strictures.
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Affiliation(s)
- Benjamin Charles Norton
- Department of Gastroenterology, Digestive Diseases and Surgery Institute, Cleveland Clinic London, 33 Grosvenor Place, London, SW1X 7HY, UK; Centre for Obesity Research, Department of Medicine, University College London, Rayne Institute, 5 University St, London, WC1E 6JF, UK.
| | - Apostolis Papaefthymiou
- Department of Gastroenterology, Digestive Diseases and Surgery Institute, Cleveland Clinic London, 33 Grosvenor Place, London, SW1X 7HY, UK
| | - Nasar Aslam
- Department of Gastroenterology, University College London Hospital, 235 Euston Road, London, NW1 2BU, UK
| | - Andrea Telese
- Department of Gastroenterology, Digestive Diseases and Surgery Institute, Cleveland Clinic London, 33 Grosvenor Place, London, SW1X 7HY, UK; Division of Surgery and Interventional Science, University College London, Royal Free Hospital, 10 Pond Street, London, NW3 2PS, UK
| | - Charles Murray
- Department of Gastroenterology, Digestive Diseases and Surgery Institute, Cleveland Clinic London, 33 Grosvenor Place, London, SW1X 7HY, UK
| | - Alberto Murino
- Department of Gastroenterology, Digestive Diseases and Surgery Institute, Cleveland Clinic London, 33 Grosvenor Place, London, SW1X 7HY, UK
| | - Gavin Johnson
- Department of Gastroenterology, Digestive Diseases and Surgery Institute, Cleveland Clinic London, 33 Grosvenor Place, London, SW1X 7HY, UK
| | - Rehan Haidry
- Department of Gastroenterology, Digestive Diseases and Surgery Institute, Cleveland Clinic London, 33 Grosvenor Place, London, SW1X 7HY, UK
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Schulz D, Koob I, Pickhard A, Schmid RM, Abdelhafez M. Risk factors for total laryngectomy associated proximal esophageal stricture formation in head and neck cancer patients. ZEITSCHRIFT FUR GASTROENTEROLOGIE 2024; 62:193-198. [PMID: 37758037 DOI: 10.1055/a-2150-2689] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/03/2023]
Abstract
BACKGROUND Development of esophageal strictures is common after the total laryngectomy of head and neck cancer patients. While endoscopic techniques like dilatation by balloon or Salvary bougies are well established, risk factors and pathophysiology for development of refractory strictures are less well understood. OBJECTIVE To evaluate risk factors associated with occurrence and recurrence of total-laryngectomy-associated esophageal strictures in head and neck cancer patients. METHODS We analyzed retrospectively a cohort of 170 head and neck squamous cell carcinoma patients, who underwent total laryngectomy between 2007 and 2017. The outcome measure was laryngectomy-associated proximal esophageal stricture needing an endoscopic dilatation by using a balloon or Savary dilators. RESULTS Of the 170 patients in the cohort, 32 (18.8%) developed strictures. Mean time between surgery and first endoscopic intervention was 24.4 months. Significant predictive factors were age ≥ 65 (p=0.017), nodal status N> 1 (p=0.003), continued alcohol abuse after surgery (p=0.005) and diabetes mellitus (p=0.005). In a subgroup, 17 of 32 patients developed refractory strictures and needed more than three dilatations to relieve dysphagia. Postoperative mean (p=0.016) and maximum (p=0.015) C-reactive protein (CRP) were predictive for refractory strictures. CONCLUSION Symptomatic strictures occurred in 18.8% of the cases. Age, nodal status N>1, continued alcohol abuse and diabetes mellitus were predictive factors. For refractory stenosis (>3 dilatations needed) mean and maximum postoperative CRP were predictive. This may indicate that systemic inflammatory response post-surgery is involved in the stricture formation process.
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Affiliation(s)
- Dominik Schulz
- Klinik und Poliklinik für Innere Medizin II, Klinikum rechts der Isar der Technischen Universität München, München, Germany
| | - Isabelle Koob
- Department of Head and Neck Surgery, Klinikum rechts der Isar der Technischen Universität München, München, Germany
| | - Anja Pickhard
- Department of Head and Neck Surgery, Klinikum rechts der Isar der Technischen Universität München, München, Germany
| | - Roland M Schmid
- Klinik und Poliklinik für Innere Medizin II, Klinikum rechts der Isar der Technischen Universität München, München, Germany
| | - Mohamed Abdelhafez
- Klinik und Poliklinik für Innere Medizin II, Klinikum rechts der Isar der Technischen Universität München, München, Germany
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Chakrabarty N, Mahajan A, Prabhash K, Patil P, Chowhan M, Munmmudi N, Niyogi D, Dabkara D, Singh S, Singh A, Devarmani S, Dhull VS. Imaging Recommendations for Diagnosis, Staging, and Management of Esophageal Cancer. Indian J Med Paediatr Oncol 2023. [DOI: 10.1055/s-0042-1760324] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/12/2023] Open
Abstract
AbstractEarly staging and treatment initiation affect prognosis of patients with esophageal and esophagogastric junction cancer; hence, it is imperative to have knowledge of proper choice of imaging modality for staging of these patients, to effectively convey relevant imaging findings to the treating physician/surgeon. It is also essential to be aware of pertinent imaging findings that need to be conveyed to the treating physician/surgeon at staging, and after treatment, including post-therapy complications (if any), so as to provide timely management to such patients. In this article, we have provided imaging guidelines for diagnosis, staging, post-therapy response evaluation, follow-up, and assessment of post-therapy complications of esophageal and esophagogastric junction cancer in a systematic manner. Besides, risk factors and clinical workup have also been elucidated. We have also attached comprehensive staging and post-therapy contrast-enhanced computed tomography and fluorodeoxyglucose-positron emission tomography/computed tomography-based synoptic reporting formats “ECI-RADS” and “pECI-RADS,” respectively, for esophageal and esophagogastric junction cancer in the supplement, for effective communication of imaging findings between a radiologist and the treating physician/surgeon.
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Affiliation(s)
- Nivedita Chakrabarty
- Department of Radiodiagnosis, Tata Memorial Centre, Homi Bhabha National Institute (HBNI), Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - Abhishek Mahajan
- The Clatterbridge Cancer Centre NHS Foundation Trust, Liverpool, United Kingdom
| | - Kumar Prabhash
- Department of Medical Oncology, Tata Memorial Centre, Homi Bhabha National Institute (HBNI), Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - Prachi Patil
- Department of Digestive Diseases and Clinical Nutrition, Tata Memorial Centre, Homi Bhabha National Institute (HBNI), Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - Manoranjan Chowhan
- Department of Nuclear Medicine and PET/CT, Aditya Birla Memorial Hospital, Pune, Maharashtra, India
| | - Naveen Munmmudi
- Department of Radiation Oncology, Tata Memorial Centre, Homi Bhabha National Institute (HBNI), Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - Devayani Niyogi
- Department of Surgical Oncology, Tata Memorial Centre, Homi Bhabha National Institute (HBNI), Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - Deepak Dabkara
- Department of Oncology, CHL Hospitals, Indore, Madhya Pradesh, India
| | - Suryaveer Singh
- Department of Radiodiagnosis, Tata Memorial Centre, Homi Bhabha National Institute (HBNI), Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - Ajaykumar Singh
- Department of Medical Oncology, Tata Memorial Centre, Homi Bhabha National Institute (HBNI), Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - Sanjana Devarmani
- Department of Radiodiagnosis, Tata Memorial Centre, Homi Bhabha National Institute (HBNI), Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - Varun Singh Dhull
- Department of Nuclear Medicine and PET/CT, Aditya Birla Memorial Hospital, Pune, Maharashtra, India
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James AR, Thangavel S, Raja K, Saxena SK. Oesophagoscopy in a Treated Oral Cavity Carcinoma Patient: A Case Report and Review. Indian J Otolaryngol Head Neck Surg 2022; 74:6065-6068. [PMID: 36742667 PMCID: PMC9895646 DOI: 10.1007/s12070-021-02727-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2021] [Accepted: 06/27/2021] [Indexed: 02/07/2023] Open
Abstract
Vegetable matter, especially fruit seed impaction, is uncommon in Otolaryngology practice. If it happens, there should be a possibility of abnormality in the oesophagus like stricture, web, malignancy, trauma or diverticulum. Here we present a case of seed as a foreign body oesophagus in a patient who was a known case of carcinoma left buccal mucosa status post left hemimandibulectomy with flap reconstruction Radiotherapy 20 years ago. We explained the practical and logistic issues while intubation and doing oesophagoscopy in this patient.
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Affiliation(s)
- Antony Raj James
- Department of ENT, Jawaharlal Institute of Post Graduate Medical Education and Research (JIPMER), Pondicherry, 605006 India
| | - Saranya Thangavel
- Department of ENT, Jawaharlal Institute of Post Graduate Medical Education and Research (JIPMER), Pondicherry, 605006 India
| | - Kalaiarasi Raja
- Department of ENT, Jawaharlal Institute of Post Graduate Medical Education and Research (JIPMER), Pondicherry, 605006 India
| | - Sunil Kumar Saxena
- Department of ENT, Jawaharlal Institute of Post Graduate Medical Education and Research (JIPMER), Pondicherry, 605006 India
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Abstract
The benefit of radiation is immense in the field of gastroenterology. Radiation is used daily in different gastrointestinal imaging and diagnostic and therapeutic interventional procedures. Radiotherapy is one of the primary modalities of treatment of gastrointestinal malignancies. There are various modalities of radiotherapy. Radiotherapy can injure malignant cells by directly damaging DNA, RNA, proteins, and lipids and indirectly by forming free radicals. External beam radiation, internal beam radiation and radio-isotope therapy are the major ways of delivering radiation to the malignant tissue. Radiation can also cause inflammation, fibrosis, organ dysfunction, and malignancy. Patients with repeated exposure to radiation for diagnostic imaging and therapeutic procedures are at slightly increased risk of malignancy. Gastrointestinal endoscopists performing fluoroscopy-guided procedures are also at increased risk of malignancy and cataract formation. The radiological protection society recommends certain preventive and protective measures to avoid side effects of radiation. Gastrointestinal complications related to radiation therapy for oncologic processes, and exposure risks for patients and health care providers involved in diagnostic or therapeutic imaging will be discussed in this review.
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Affiliation(s)
- Monjur Ahmed
- Division of Gastroenterology and Hepatology, Thomas Jefferson University, Philadelphia, PA 19107, USA,Corresponding Author: Monjur Ahmed, Division of Gastroenterology and Hepatology, Thomas Jefferson University, Philadelphia, PA 19107, USA.
| | - Razin Ahmed
- California Cancer Associates for Research and Excellence, Fresno, CA, USA
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Claassen PL, Eggleston CJ, Villa NA. Managing Complications Following Endoscopic Myotomy as a Treatment for Upper Esophageal Sphincter (UES) Achalasia: A Case Report. Cureus 2022; 14:e30613. [DOI: 10.7759/cureus.30613] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/24/2022] [Indexed: 11/05/2022] Open
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Rocha PHP, Reali RM, Decnop M, Souza SA, Teixeira LAB, Júnior AL, Sarpi MO, Cintra MB, Pinho MC, Garcia MRT. Adverse Radiation Therapy Effects in the Treatment of Head and Neck Tumors. Radiographics 2022; 42:806-821. [PMID: 35302867 DOI: 10.1148/rg.210150] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Whether used as a single modality or as part of a combined approach, radiation therapy (RT) plays an essential role in the treatment of several head and neck malignancies. Despite the improvement in radiation delivery techniques, normal structures in the vicinity of the target area remain susceptible to a wide range of adverse effects. Given their high incidence, some of these effects are referred to as expected postradiation changes (eg, mucositis, sialadenitis, and edema), while others are considered true complications, meaning they should not be expected and can even represent life-threatening conditions (eg, radionecrosis, fistulas, and radiation-induced neoplasms). Also, according to their timing of onset, these deleterious effects can be divided into four groups: acute (during RT), subacute (within weeks to months), delayed onset (within months to years), and very delayed onset (after several years).The authors provide a comprehensive review of the most important radiation-induced changes related to distinct head and neck sites, focusing on their typical cross-sectional imaging features and correlating them with the time elapsed after treatment. Radiologists should not only be familiar with these imaging findings but also actively seek essential clinical data at the time of interpretation (including knowledge of the RT dose and time, target site, and manifesting symptoms) to better recognize imaging findings, avoid pitfalls and help guide appropriate management. © RSNA, 2022.
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Affiliation(s)
- Pedro H P Rocha
- From the Division of Head and Neck Radiology, Diagnósticos da América SA/DASA, São Paulo, Brazil (P.H.P.R., R.M.R., S.A.S., M.O.S., M.B.C., M.R.T.G.); Division of Head and Neck Radiology, Instituto Nacional do Câncer (INCA), Rio de Janeiro, Brazil (M.D.); Departments of Diagnostic Imaging (S.A.S., M.B.C.) and Radiation Therapy (L.A.B.T.), Instituto do Câncer do Estado de São Paulo (ICESP) do HCFMUSP, São Paulo, Brazil; Department of Radiation Therapy, Hospital Santa Paula, São Paulo, Brazil (L.A.B.T.); Division of Head and Neck and Neuroradiology, Grupo São Camilo/ DASA, Maringá, Brazil (A.L.J.); Division of Head and Neck Radiology, Instituto de Radiologia, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (InRad/ HC-FMUSP), São Paulo, Brazil (M.O.S.); and Department of Radiology, UT Southwestern Medical Center, Dallas, Tex (M.C.P.)
| | - Raphael M Reali
- From the Division of Head and Neck Radiology, Diagnósticos da América SA/DASA, São Paulo, Brazil (P.H.P.R., R.M.R., S.A.S., M.O.S., M.B.C., M.R.T.G.); Division of Head and Neck Radiology, Instituto Nacional do Câncer (INCA), Rio de Janeiro, Brazil (M.D.); Departments of Diagnostic Imaging (S.A.S., M.B.C.) and Radiation Therapy (L.A.B.T.), Instituto do Câncer do Estado de São Paulo (ICESP) do HCFMUSP, São Paulo, Brazil; Department of Radiation Therapy, Hospital Santa Paula, São Paulo, Brazil (L.A.B.T.); Division of Head and Neck and Neuroradiology, Grupo São Camilo/ DASA, Maringá, Brazil (A.L.J.); Division of Head and Neck Radiology, Instituto de Radiologia, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (InRad/ HC-FMUSP), São Paulo, Brazil (M.O.S.); and Department of Radiology, UT Southwestern Medical Center, Dallas, Tex (M.C.P.)
| | - Marcos Decnop
- From the Division of Head and Neck Radiology, Diagnósticos da América SA/DASA, São Paulo, Brazil (P.H.P.R., R.M.R., S.A.S., M.O.S., M.B.C., M.R.T.G.); Division of Head and Neck Radiology, Instituto Nacional do Câncer (INCA), Rio de Janeiro, Brazil (M.D.); Departments of Diagnostic Imaging (S.A.S., M.B.C.) and Radiation Therapy (L.A.B.T.), Instituto do Câncer do Estado de São Paulo (ICESP) do HCFMUSP, São Paulo, Brazil; Department of Radiation Therapy, Hospital Santa Paula, São Paulo, Brazil (L.A.B.T.); Division of Head and Neck and Neuroradiology, Grupo São Camilo/ DASA, Maringá, Brazil (A.L.J.); Division of Head and Neck Radiology, Instituto de Radiologia, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (InRad/ HC-FMUSP), São Paulo, Brazil (M.O.S.); and Department of Radiology, UT Southwestern Medical Center, Dallas, Tex (M.C.P.)
| | - Soraia A Souza
- From the Division of Head and Neck Radiology, Diagnósticos da América SA/DASA, São Paulo, Brazil (P.H.P.R., R.M.R., S.A.S., M.O.S., M.B.C., M.R.T.G.); Division of Head and Neck Radiology, Instituto Nacional do Câncer (INCA), Rio de Janeiro, Brazil (M.D.); Departments of Diagnostic Imaging (S.A.S., M.B.C.) and Radiation Therapy (L.A.B.T.), Instituto do Câncer do Estado de São Paulo (ICESP) do HCFMUSP, São Paulo, Brazil; Department of Radiation Therapy, Hospital Santa Paula, São Paulo, Brazil (L.A.B.T.); Division of Head and Neck and Neuroradiology, Grupo São Camilo/ DASA, Maringá, Brazil (A.L.J.); Division of Head and Neck Radiology, Instituto de Radiologia, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (InRad/ HC-FMUSP), São Paulo, Brazil (M.O.S.); and Department of Radiology, UT Southwestern Medical Center, Dallas, Tex (M.C.P.)
| | - Lorine A B Teixeira
- From the Division of Head and Neck Radiology, Diagnósticos da América SA/DASA, São Paulo, Brazil (P.H.P.R., R.M.R., S.A.S., M.O.S., M.B.C., M.R.T.G.); Division of Head and Neck Radiology, Instituto Nacional do Câncer (INCA), Rio de Janeiro, Brazil (M.D.); Departments of Diagnostic Imaging (S.A.S., M.B.C.) and Radiation Therapy (L.A.B.T.), Instituto do Câncer do Estado de São Paulo (ICESP) do HCFMUSP, São Paulo, Brazil; Department of Radiation Therapy, Hospital Santa Paula, São Paulo, Brazil (L.A.B.T.); Division of Head and Neck and Neuroradiology, Grupo São Camilo/ DASA, Maringá, Brazil (A.L.J.); Division of Head and Neck Radiology, Instituto de Radiologia, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (InRad/ HC-FMUSP), São Paulo, Brazil (M.O.S.); and Department of Radiology, UT Southwestern Medical Center, Dallas, Tex (M.C.P.)
| | - Ademar Lucas Júnior
- From the Division of Head and Neck Radiology, Diagnósticos da América SA/DASA, São Paulo, Brazil (P.H.P.R., R.M.R., S.A.S., M.O.S., M.B.C., M.R.T.G.); Division of Head and Neck Radiology, Instituto Nacional do Câncer (INCA), Rio de Janeiro, Brazil (M.D.); Departments of Diagnostic Imaging (S.A.S., M.B.C.) and Radiation Therapy (L.A.B.T.), Instituto do Câncer do Estado de São Paulo (ICESP) do HCFMUSP, São Paulo, Brazil; Department of Radiation Therapy, Hospital Santa Paula, São Paulo, Brazil (L.A.B.T.); Division of Head and Neck and Neuroradiology, Grupo São Camilo/ DASA, Maringá, Brazil (A.L.J.); Division of Head and Neck Radiology, Instituto de Radiologia, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (InRad/ HC-FMUSP), São Paulo, Brazil (M.O.S.); and Department of Radiology, UT Southwestern Medical Center, Dallas, Tex (M.C.P.)
| | - Maíra O Sarpi
- From the Division of Head and Neck Radiology, Diagnósticos da América SA/DASA, São Paulo, Brazil (P.H.P.R., R.M.R., S.A.S., M.O.S., M.B.C., M.R.T.G.); Division of Head and Neck Radiology, Instituto Nacional do Câncer (INCA), Rio de Janeiro, Brazil (M.D.); Departments of Diagnostic Imaging (S.A.S., M.B.C.) and Radiation Therapy (L.A.B.T.), Instituto do Câncer do Estado de São Paulo (ICESP) do HCFMUSP, São Paulo, Brazil; Department of Radiation Therapy, Hospital Santa Paula, São Paulo, Brazil (L.A.B.T.); Division of Head and Neck and Neuroradiology, Grupo São Camilo/ DASA, Maringá, Brazil (A.L.J.); Division of Head and Neck Radiology, Instituto de Radiologia, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (InRad/ HC-FMUSP), São Paulo, Brazil (M.O.S.); and Department of Radiology, UT Southwestern Medical Center, Dallas, Tex (M.C.P.)
| | - Murilo B Cintra
- From the Division of Head and Neck Radiology, Diagnósticos da América SA/DASA, São Paulo, Brazil (P.H.P.R., R.M.R., S.A.S., M.O.S., M.B.C., M.R.T.G.); Division of Head and Neck Radiology, Instituto Nacional do Câncer (INCA), Rio de Janeiro, Brazil (M.D.); Departments of Diagnostic Imaging (S.A.S., M.B.C.) and Radiation Therapy (L.A.B.T.), Instituto do Câncer do Estado de São Paulo (ICESP) do HCFMUSP, São Paulo, Brazil; Department of Radiation Therapy, Hospital Santa Paula, São Paulo, Brazil (L.A.B.T.); Division of Head and Neck and Neuroradiology, Grupo São Camilo/ DASA, Maringá, Brazil (A.L.J.); Division of Head and Neck Radiology, Instituto de Radiologia, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (InRad/ HC-FMUSP), São Paulo, Brazil (M.O.S.); and Department of Radiology, UT Southwestern Medical Center, Dallas, Tex (M.C.P.)
| | - Marco C Pinho
- From the Division of Head and Neck Radiology, Diagnósticos da América SA/DASA, São Paulo, Brazil (P.H.P.R., R.M.R., S.A.S., M.O.S., M.B.C., M.R.T.G.); Division of Head and Neck Radiology, Instituto Nacional do Câncer (INCA), Rio de Janeiro, Brazil (M.D.); Departments of Diagnostic Imaging (S.A.S., M.B.C.) and Radiation Therapy (L.A.B.T.), Instituto do Câncer do Estado de São Paulo (ICESP) do HCFMUSP, São Paulo, Brazil; Department of Radiation Therapy, Hospital Santa Paula, São Paulo, Brazil (L.A.B.T.); Division of Head and Neck and Neuroradiology, Grupo São Camilo/ DASA, Maringá, Brazil (A.L.J.); Division of Head and Neck Radiology, Instituto de Radiologia, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (InRad/ HC-FMUSP), São Paulo, Brazil (M.O.S.); and Department of Radiology, UT Southwestern Medical Center, Dallas, Tex (M.C.P.)
| | - Marcio R T Garcia
- From the Division of Head and Neck Radiology, Diagnósticos da América SA/DASA, São Paulo, Brazil (P.H.P.R., R.M.R., S.A.S., M.O.S., M.B.C., M.R.T.G.); Division of Head and Neck Radiology, Instituto Nacional do Câncer (INCA), Rio de Janeiro, Brazil (M.D.); Departments of Diagnostic Imaging (S.A.S., M.B.C.) and Radiation Therapy (L.A.B.T.), Instituto do Câncer do Estado de São Paulo (ICESP) do HCFMUSP, São Paulo, Brazil; Department of Radiation Therapy, Hospital Santa Paula, São Paulo, Brazil (L.A.B.T.); Division of Head and Neck and Neuroradiology, Grupo São Camilo/ DASA, Maringá, Brazil (A.L.J.); Division of Head and Neck Radiology, Instituto de Radiologia, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (InRad/ HC-FMUSP), São Paulo, Brazil (M.O.S.); and Department of Radiology, UT Southwestern Medical Center, Dallas, Tex (M.C.P.)
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Spaulding SL, Ansari E, Xing MH, Sandler ML, O'Malley QF, Ho R, Spitzer H, Levy J, Ganz C, Khorsandi AS, Mundi N, Urken ML. Diagnosis and management of pharyngoesophageal stenosis: A comprehensive approach to prophylactic, endoscopic, and reconstructive treatment options. Am J Otolaryngol 2021; 42:103003. [PMID: 33894689 DOI: 10.1016/j.amjoto.2021.103003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Accepted: 03/15/2021] [Indexed: 12/30/2022]
Abstract
BACKGROUND Pharyngoesophageal stenosis (PES) is a serious complication that substantially impacts functional outcomes and quality of life (QOL) for up to a third of head and neck cancer patients who undergo radiotherapy. Dysphagia is often multifactorial in nature and is a devastating complication of treatment that impacts patients' QOL, general health and overall wellbeing. The authors detail the clinical presentation, risk factors, imaging characteristics, preventive measures, and multimodality treatment options for PES. METHODS The authors present a comprehensive management algorithm for PES, including treatment by dilation, stenting, spray cryotherapy and dilation, and reconstructive treatment options utilizing different pedicled and free flaps. RESULTS The authors advocate for a thorough assessment of the extent and degree of pharyngoesophageal involvement of PES to determine the optimal management strategy. CONCLUSIONS The development of post treatment dysphagia requires appropriate imaging and biopsy, when indicated, to rule out the presence of persistent/recurrent cancer. Multidisciplinary management by a team of physicians well-versed in the range of diagnostic and therapeutic interventions available for PES is critical to its successful management.
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Affiliation(s)
- Sarah L Spaulding
- The Thyroid, Head, and Neck Cancer (THANC) Foundation, New York, NY 10003, United States of America
| | - Edward Ansari
- Department of Otolaryngology-Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, NY 10003, United States of America
| | - Monica H Xing
- The Thyroid, Head, and Neck Cancer (THANC) Foundation, New York, NY 10003, United States of America.
| | - Mykayla L Sandler
- The Thyroid, Head, and Neck Cancer (THANC) Foundation, New York, NY 10003, United States of America
| | - Quinn F O'Malley
- The Thyroid, Head, and Neck Cancer (THANC) Foundation, New York, NY 10003, United States of America
| | - Rebecca Ho
- The Thyroid, Head, and Neck Cancer (THANC) Foundation, New York, NY 10003, United States of America
| | - Hannah Spitzer
- The Thyroid, Head, and Neck Cancer (THANC) Foundation, New York, NY 10003, United States of America
| | - Juliana Levy
- The Thyroid, Head, and Neck Cancer (THANC) Foundation, New York, NY 10003, United States of America
| | - Cindy Ganz
- The Thyroid, Head, and Neck Cancer (THANC) Foundation, New York, NY 10003, United States of America
| | - Azita S Khorsandi
- Department of Radiology, New York Eye and Ear Infirmary, New York, NY 10003, United States of America
| | - Neil Mundi
- Department of Otolaryngology-Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, NY 10003, United States of America
| | - Mark L Urken
- Department of Otolaryngology-Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, NY 10003, United States of America
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Camprodon G, Huguet F. Unrecognized digestive toxicities of radiation therapy. Cancer Radiother 2021; 25:723-728. [PMID: 34391649 DOI: 10.1016/j.canrad.2021.07.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2021] [Revised: 07/19/2021] [Accepted: 07/24/2021] [Indexed: 12/16/2022]
Abstract
The aim of this article is to review unrecognized toxicities resulting from radiation therapy of digestive neoplasms. Due to their precocious occurrence, acute toxicities are well-known by radiation oncologist, and their treatment well-established. Thus, acute toxicities will not be described in this review. We will focus on incidence, diagnosis, and management of late and uncommon toxicities occurring in the digestive tract and digestive organs. Prevention, by respecting healthy tissues constraints, is the main tool to reduce incidence of those rare complications. Nonetheless, once installed, late toxicities remain a major burden in terms of quality of life and can even be life threatening. Hence, information and education about their diagnosis and management is important.
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Affiliation(s)
- G Camprodon
- Service d'Oncologie Médicale, Institut Gustave Roussy, 114, rue Edouard Vaillant, 94805 Villejuif, France.
| | - F Huguet
- Service d'Oncologie Radiothérapie, Hôpital Tenon, Sorbonne Université, AP-HP, Paris, France
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Kotani S, Shibagaki K, Yuki T, Aimi M, Mikami H, Izumi D, Yamashita N, Takahashi Y, Fukuba N, Ishimura N, Ishihara S. A multicenter retrospective study of the esophageal triamcinolone acetonide-filling method in patients with extensive esophageal endoscopic submucosal dissection. Scand J Gastroenterol 2021; 56:647-655. [PMID: 33856943 DOI: 10.1080/00365521.2021.1910998] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVE Endoscopic submucosal dissection (ESD) for extensive esophageal cancer is sometimes associated with post-ESD stenosis, despite preventative steroid therapy. In this retrospective multicenter analysis, we evaluated the factors associated with therapy resistance. MATERIALS AND METHODS We enrolled 73 patients with 75 extensive esophageal cancers treated with ESD. Stenosis prevention was performed using two esophageal triamcinolone acetonide (TA)-fillings, and repeated if stenosis was found on follow-up. Therapy-resistance factors associated with incidence of severe stenosis requiring endoscopic balloon dilation (EBD) were evaluated, including age, gender, previous treatment history, tumor location, morphology, resection size, histologic type, invasion depth, and horizontal resection grade (HR-grade 1, ≥ 9/12 and <10/12 of the circumference; grade 2, ≥ 10/12 and <11/12; grade 3, ≥ 11/12 but not circumferential; and grade 4, entirely circumferential). RESULTS Severe stenosis occurred in 17.3%(13/75) of cases, with a median of two EBDs (range, 1-6 times). Severe stenosis was significantly associated with HR-grade elevation and previous treatment history (p < .05); multivariate analysis showed both as independent therapy-resistance factors (p < .05). Patients without previous treatment history demonstrated severe stenosis at 12.9%(9/70): 0%(0/26) HR-grade 1, 18.8%(3/16) grade 2, 17.6%(3/17) grade 3, and 27.3%(3/11) grade 4, showing a risk of HR-grade 2 or more resection but an acceptable stenosis prevention even after entirely circumferential resection. Conversely, patients with previous treatment history demonstrated severe stenosis at a high frequency of 80%(4/5). CONCLUSIONS Esophageal TA-filling is a promising stenosis-preventive steroid therapy, even in entirely circumferential ESD cases. However, HR-grade 2 or more elevation and previous treatment history were independently associated with therapy resistance.
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Affiliation(s)
- Satoshi Kotani
- Department of Gastroenterology, Faculty of Medicine, Shimane University, Izumo, Japan
| | - Kotaro Shibagaki
- Department of Gastroenterology, Faculty of Medicine, Shimane University, Izumo, Japan
| | - Takafumi Yuki
- Division of Gastroenterology, Matsue Red Cross Hospital, Matsue, Japan
| | - Masahito Aimi
- Department of Gastroenterology, Tottori Municipal Hospital, Tottori, Japan
| | - Hironobu Mikami
- Department of Gastroenterology, Faculty of Medicine, Shimane University, Izumo, Japan
| | - Daisuke Izumi
- Department of Gastroenterology, Faculty of Medicine, Shimane University, Izumo, Japan
| | - Noritsugu Yamashita
- Department of Gastroenterology, Faculty of Medicine, Shimane University, Izumo, Japan
| | - Yusuke Takahashi
- Department of Gastroenterology, Faculty of Medicine, Shimane University, Izumo, Japan
| | - Nobuhiko Fukuba
- Department of Gastroenterology, Izumo City General Medical Center, Izumo, Japan
| | - Norihisa Ishimura
- Department of Gastroenterology, Faculty of Medicine, Shimane University, Izumo, Japan
| | - Shunji Ishihara
- Department of Gastroenterology, Faculty of Medicine, Shimane University, Izumo, Japan
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Akahane K, Shirai K, Wakatsuki M, Ogawa K, Minato K, Hamamoto K, Takahashi S, Suzuki K, Takahashi J, Rikiyama T, Matsumoto K, Mashima H. Severe esophageal stenosis in a patient with metastatic colon cancer following palliative radiotherapy, ramucirumab, and chemotherapy. Clin Case Rep 2020; 8:919-922. [PMID: 32477545 PMCID: PMC7250969 DOI: 10.1002/ccr3.2751] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2019] [Revised: 01/31/2020] [Accepted: 02/05/2020] [Indexed: 12/31/2022] Open
Abstract
Antiangiogenic agents, such as ramucirumab, should be cautiously administered along with radiotherapy because of the enhanced risk of adverse events.
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Affiliation(s)
- Keiko Akahane
- Department of RadiologySaitama Medical CenterJichi Medical UniversitySaitamaJapan
| | - Katsuyuki Shirai
- Department of RadiologySaitama Medical CenterJichi Medical UniversitySaitamaJapan
| | | | - Kazunari Ogawa
- Department of RadiologyJichi Medical UniversityShimotsukeJapan
| | - Kyosuke Minato
- Department of RadiologySaitama Medical CenterJichi Medical UniversitySaitamaJapan
| | - Kohei Hamamoto
- Department of RadiologySaitama Medical CenterJichi Medical UniversitySaitamaJapan
| | | | - Koichi Suzuki
- Department of SurgerySaitama Medical CenterJichi Medical UniversitySaitamaJapan
| | - Jun Takahashi
- Department of SurgerySaitama Medical CenterJichi Medical UniversitySaitamaJapan
| | - Toshiki Rikiyama
- Department of SurgerySaitama Medical CenterJichi Medical UniversitySaitamaJapan
| | - Keita Matsumoto
- Department of GastroenterologySaitama Medical CenterJichi Medical UniversitySaitamaJapan
| | - Hirosato Mashima
- Department of GastroenterologySaitama Medical CenterJichi Medical UniversitySaitamaJapan
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Abstract
OPINION STATEMENT PURPOSE OF REVIEW: Esophageal stents are used in clinical practice for endoscopic treatment of a wide variety of esophageal diseases and conditions. This review provides key principles and a literature update on the utility and limitations of esophageal stenting in clinical practice. RECENT FINDINGS Indications for esophageal stenting can be subdivided into two groups. The first group consists of patients with malignant or benign dysphagia, in which an esophageal stent restores luminal patency. In the past years, temporary stent placement has increasingly been used in the therapeutic management of refractory benign esophageal strictures. When endoscopic repeated bougie dilation and other endoscopic treatment modalities have failed, an esophageal stent could be considered. Based on the literature, a fully covered self-expandable metal stent may be the preferred choice for the treatment of both malignant and benign dysphagia. The second group consists of patients with leakage from the esophageal lumen into the surrounding tissue. Esophageal leakage can be subdivided into three forms, benign esophageal perforations (iatrogenic and spontaneous), anastomotic leakage after reconstructive esophageal surgery, and fistula. In a carefully selected group of patients, a covered esophageal stent may be used for sealing off the leakage, thereby preventing further contamination of the tissue surrounding the defect. The past few years, several validated prediction tools have been developed that may assist clinicians in the selection of patients eligible for esophageal stent placement. Based on retrospective studies and expert opinion, a partially or fully covered self-expandable metal stent may have a role in treatment of esophageal leakage. Research do date supports the utilization of esophageal stents for the treatment of malignant or benign dysphagia and esophageal leakage.
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Affiliation(s)
- Bram D Vermeulen
- Department of Gastroenterology and Hepatology, Radboud University Medical Center, Geert Grooteplein-Zuid 8 (route 455), 6500, HB, Nijmegen, the Netherlands.
| | - Peter D Siersema
- Department of Gastroenterology and Hepatology, Radboud University Medical Center, Geert Grooteplein-Zuid 8 (route 455), 6500, HB, Nijmegen, the Netherlands
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Martins D, Pires S, Pimentel-Nunes P, Almeida Silva R, Dias CC, Dinis-Ribeiro M. Endoscopic Dilation of Pharyngoesophageal Strictures: There Are More Dimensions than a Diameter. GE-PORTUGUESE JOURNAL OF GASTROENTEROLOGY 2018; 25:291-298. [PMID: 30480046 DOI: 10.1159/000486608] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/06/2017] [Accepted: 01/04/2018] [Indexed: 12/19/2022]
Abstract
Background/Aims Dysphagia due to benign pharyngoesophageal strictures (PES) often requires repeated dilations; however, a uniform definition for the therapeutic efficacy of this technique has not been yet established. We aimed to assess the overall efficacy of endoscopic dilation of pharyngoesophageal anastomotic or post-radiotherapy (post-RT) strictures. Methods The data of 48 patients with post-RT (n = 29) or anastomotic PES (n = 19) submitted to endoscopic dilation during a 3-year period were retrospectively assessed. The Kochman criteria were used to determine refractoriness and recurrence. Patients were asked to answer a questionnaire determining prospectively the dilation program efficacy as (a) dysphagia improvement, (b) dysphagia resolution, (c) need for further dilations, or (d) percutaneous endoscopic gastrostomy (PEG) during the previous 6 months. Need for additional therapy was considered an inefficacy criterion. Results The median number of dilations per patient was 4 (total of 296 dilations) with a median follow-up of 29 months. The mean predilation dysphagia Mellow-Pinkas score was 3 and the initial stenosis diameter was 7 mm. Fifteen and 29% of patients presented with the Kochman criteria for refractory and recurrent strictures, respectively. Moreover, 96 and 60% showed dysphagia improvement and resolution, respectively. Seventy-five-percent did not require dilations during 6 months, and 89% did not require PEG. From the patients' perspective, overall efficacy was achieved in 58% of cases. Nine additional therapies were required. Number of dilations (OR 0.7), stricture diameter (OR 2.2), and nonrecurrence criteria (OR 14.2) appeared as significant predictors of overall efficacy, whereas refractory stenosis criteria did not. Conclusions Endoscopic dilation seems to be effective for patients with dysphagia after RT or surgery, especially when assessed as patient perception of improvement. Narrow strictures, recurrent ones, and strictures requiring a higher number of dilations may predict worse outcomes. Key Message Health professionals should establish well-defined efficacy criteria for dilations and base their decision beyond exclusively objective measurements.
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Affiliation(s)
- Diana Martins
- Gastroenterology Department, Tondela-Viseu Hospital Center, Viseu, Portugal
| | - Sara Pires
- Gastroenterology Department, Espirito Santo Hospital, Évora, Portugal
| | - Pedro Pimentel-Nunes
- Gastroenterology Department, Portuguese Oncology Institute of Porto, Porto, Portugal.,CINTESIS - Center for Health Technology and Services Research, Porto, Portugal.,CIDES-FMUP - Faculty of Medicine of the University of Porto, Porto, Portugal
| | - Rui Almeida Silva
- Gastroenterology Department, Portuguese Oncology Institute of Porto, Porto, Portugal
| | - Claúdia Camila Dias
- CINTESIS - Center for Health Technology and Services Research, Porto, Portugal.,Department of Community Medicine, Information and Decision in Health, Faculty of Medicine of the University of Porto, Porto, Portugal
| | - Mário Dinis-Ribeiro
- Gastroenterology Department, Portuguese Oncology Institute of Porto, Porto, Portugal.,CINTESIS - Center for Health Technology and Services Research, Porto, Portugal.,CIDES-FMUP - Faculty of Medicine of the University of Porto, Porto, Portugal
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