Severe Refractory Post-Radiation Strictures: Lessons Learned from Long-term Follow-up after Combined Antegrade...

Area of Science:

• Gastroenterology
• Oncology
• Surgical Procedures

Background:

• Head and neck cancer patients often develop esophageal strictures after chemoradiation.
• Severe strictures can lead to complete esophageal lumen obliteration and significant dysphagia.

Purpose of the Study:

• To report on an institution's experience and refined strategy for long-term management of esophageal strictures.
• To evaluate the effectiveness and safety of the Combined Antegrade Retrograde Dilation (CARD) procedure.

Main Methods:

• Retrospective analysis of 20 patients undergoing CARD procedures for post-chemoradiation esophageal strictures.
• Detailed reporting of dilation sessions, maintenance schedules, and complication rates.

Main Results:

• All 20 patients achieved luminal patency after an average of 13.9 CARD sessions per patient.
• Complications occurred in 35% of patients (2.5% of procedures), including bleeding and perforation.
• Diet and dysphagia scores were not effective in guiding maintenance dilation schedules.

Conclusions:

• The CARD procedure is effective for initial esophageal patency restoration.
• Long-term maintenance dilation is essential for sustained patency.
• Strategies to reduce complication incidence include prophylactic antibiotics, prosthesis removal, avoiding gastrostomy tract dilation, modest goals, and fluoroscopic surveillance.