title: Technique of endoscopic retrograde puncture and dilatation of total esophageal stenosis in patients with radiation-induced strictures.
abstract: BACKGROUND
  Complete esophageal stenosis can occur after external beam radiation therapy for malignancies. Treatment for this complication has traditionally involved surgery.
  
  
  METHODS
  A new technique to reestablish luminal patency is described. This minimally invasive technique involves retrograde endoscopy by means of gastrostomy tube tract and puncture of the stenotic occlusion followed by stricture dilatation. The procedure is performed under combined endoscopic and laryngoscopic guidance.
  
  
  RESULTS
  Five consecutive patients who had complete esophageal stenoses develop after radiation therapy for malignant disease underwent retrograde endoscopy by way of gastrostomy tube tracts. Stenoses were punctured under endoscopic and laryngoscopic guidance with guide wires. Strictures were dilated with wire-guided balloons or polyvinyl dilators. Luminal patency was established in all patients using this technique without procedural complications.
  
  
  CONCLUSIONS
  Endoscopic retrograde puncture and dilatation of total esophageal stenoses is safe, effective, and useful to reestablish luminal patency for radiation-induced strictures. This technique should be attempted before more invasive treatments.
authors.affiliation: Division of Gastroenterology, Department of Medicine, Hospital of the University of Pennsylvania, Division of Gastroenterology, 3400 Spruce Street, 3 Ravdin Building, Philadelphia, Pennsylvania 19104, USA.
authors.forename: Ronald J
authors.initials: RJ
authors.lastname: Lew
authors.forename: Janak N
authors.initials: JN
authors.lastname: Shah
authors.forename: Ara
authors.initials: A
authors.lastname: Chalian
authors.forename: Randal S
authors.initials: RS
authors.lastname: Weber
authors.forename: Noel N
authors.initials: NN
authors.lastname: Williams
authors.forename: Michael L
authors.initials: ML
authors.lastname: Kochman
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D004106:Dilatation; D004724:Endoscopy / Q000379:methods*; D004940:Esophageal Stenosis / Q000209:etiology / Q000628:therapy*; D005260:Female; D006801:Humans; D007828:Laryngoscopy; D008297:Male; D008875:Middle Aged; D011677:Punctures; D011878:Radiotherapy / Q000009:adverse effects*; D016896:Treatment Outcome