title: Combined antegrade and retrograde esophageal dilation for head and neck cancer-related complete esophageal stenosis.
abstract: OBJECTIVE
  Assess the safety and efficacy of combined antegrade and retrograde esophageal dilation (CARD) for complete esophageal stenosis following head and neck cancer (HNC) treatment. Review HNC dysphagia management.
  
  
  METHODS
  Retrospective review of all patients undergoing CARD following HNC treatment between May 2001 and September 2008.
  
  
  METHODS
  Forty-five patients were identified for review. Parameters assessed included: ability to obtain intraoperative esophageal patency, complications, number of dilations required, diet, and gastric tube (GT) status. Factors associated with dilation failure were analyzed.
  
  
  RESULTS
  Intraoperative esophageal patency was obtained in 91% of patients. Median number of all dilations per patient was three. Median number of CARDs per patient was one. Resumption of oral intake occurred in 36/45 (80%). Diet results included: regular or soft diet 32/45 (71%), GT removal 27/45 (60%), and GT dependence with nothing by mouth 9/45 (20%). Laryngeal and pharyngeal stenosis, radionecrosis, tracheotomy dependence, and elongated stenosis were associated with dilation failure. Complications occurred in 18/63 (29%) CARD procedures: eight pneumomediastinum, seven GT site problems, two esophageal perforations, and one pharyngeal infection. All complications resolved spontaneously or with minimal interventions.
  
  
  CONCLUSIONS
  CARD was safe and effective. Intraoperative patency was achieved in 91% of patients. Eighty percent resumed oral intake. The majority of patients had their GTs removed and resumed a soft or regular diet. Dilation failure was associated with laryngeal, pharyngeal, and excessively long esophageal stenosis, often resulting from radionecrosis. Complications were minor. CARD should be considered before relegating patients with complete esophageal stenosis to chronic GT dependence or subjecting them to laryngopharyngo esophagectomy.
authors.affiliation: Department of Surgery/Division of Otolaryngology, Brigham and Women's Hospital and Dana Farber Cancer Institute, Boston, Massachusetts 02115, USA. lgoguen@partners.org
authors.forename: Laura A
authors.initials: LA
authors.lastname: Goguen
authors.forename: Charles M
authors.initials: CM
authors.lastname: Norris
authors.forename: Michael T
authors.initials: MT
authors.lastname: Jaklitsch
authors.forename: Christopher A
authors.initials: CA
authors.lastname: Sullivan
authors.forename: Marshall R
authors.initials: MR
authors.lastname: Posner
authors.forename: Robert I
authors.initials: RI
authors.lastname: Haddad
authors.forename: Roy B
authors.initials: RB
authors.lastname: Tishler
authors.forename: Elaine
authors.initials: E
authors.lastname: Burke
authors.forename: Donald J
authors.initials: DJ
authors.lastname: Annino
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D004106:Dilatation / Q000009:adverse effects / Q000379:methods; D004435:Eating; D004940:Esophageal Stenosis / Q000209:etiology / Q000628:therapy*; D005260:Female; D006258:Head and Neck Neoplasms / Q000150:complications* / Q000628:therapy; D006801:Humans; D008297:Male; D008875:Middle Aged