Management of strictures after radiotherapy for esophageal cancer

Many esophageal cancer patients present with recurrent dysphagia after treatment with radiotherapy and are considered at high risk for further endoscopic intervention. We assessed whether the risks were really greater than those in patients not previously irradiated.

Over 6 years, 61 patients who had undergone previous radiotherapy required endoscopic dilation with or without intubation. The risk of dilating or intubating these patients was compared to that of a control group of 126 patients with similar malignancies who had not undergone previous radiotherapy.

The perforation rate for dilation in the radiotherapy group was not significantly different from that in controls (3% radiotherapy vs 4.7% in controls per procedure; 6.5% radiotherapy vs 8% in controls per patient) and was unrelated to previous laser therapy. Half the perforations in the control group occurred at the first therapeutic procedure. Endoprostheses were inserted in 48% of radiotherapy patients and 79% of controls at some stage of the illness. The risks of perforation related to intubation in each group were similar (3% radiotherapy vs 4% in controls) although tube migration was more frequent in the radiotherapy group, 21% vs 3% in controls (p = 0.005).

We conclude that there is no increased risk of perforation in endoscopic dilation or intubation for strictures occurring after radiotherapy.