title: Endoscopic lumen restoration for obstructive aphagia: outcomes of a 25-year experience.
abstract: BACKGROUND
  After chemoradiation therapy for head/neck cancer, some patients develop strictures that progress to complete pharyngoesophageal occlusion. Total lumen occlusion is less often due to other conditions. Enteral access (enterostomy tube) and good nutritional status tend to minimize the significance of dysphagia and therefore may mask recognition of impending complete lumen occlusion.
  
  
  OBJECTIVE
  Review outcomes of a 25-year experience with endoscopic lumen restoration (ELR) in 30 patients.
  
  
  METHODS
  Retrospective, case review study.
  
  
  METHODS
  Two tertiary-care referral centers.
  
  
  METHODS
  This study involved 30 consecutive patients referred for obstructive aphagia due to complete lumen occlusion, primarily after chemoradiation therapy for head/neck cancer.
  
  
  METHODS
  Antegrade and retrograde endoscopy with tri-plane fluoroscopy for penetrating the occluded segment, serial retrograde and antegrade dilations, plus swallowing rehabilitation therapy.
  
  
  METHODS
  Restoration of lumen patency, swallowing function, and removal of enteral feeding tube.
  
  
  RESULTS
  ELR was successful in 30 patients in 31 of 33 attempts (93%). Return to soft to regular diet was achieved in 15 of 30 patients (50%), and fluids to pureed food with partial percutaneous endoscopic gastrostomy nutrition was achieved in 5 of 30 patients (17%). Ten of 30 patients (33%) were considered unsafe for oral feeding because of oropharyngeal neuromotor deficits. Complications occurred in 5 of 30 patients (17%), with no prolonged sequelae, deaths, or surgery, but two stents were placed for anastomotic fistulas. The median duration of follow-up was 22.75 months.
  
  
  CONCLUSIONS
  Retrospective, case review study.
  
  
  CONCLUSIONS
  ELR by using tri-plane fluoroscopic guidance with antegrade and retrograde endoscopy and serial dilations allows lumen restoration and swallowing to some degree in a majority of patients. Engagement of a core team of specialists can provide optimal restoration of swallowing function.
authors.affiliation: Joy McCann Culverhouse Center for Swallowing Disorders, Department of Internal Medicine, University of South Florida College of Medicine, Tampa, Florida 33612, USA.
authors.forename: H Worth
authors.initials: HW
authors.lastname: Boyce
authors.forename: David S
authors.initials: DS
authors.lastname: Estores
authors.forename: Joy
authors.initials: J
authors.lastname: Gaziano
authors.forename: Tapan
authors.initials: T
authors.lastname: Padhya
authors.forename: Janet
authors.initials: J
authors.lastname: Runk
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D059248:Chemoradiotherapy / Q000009:adverse effects; D003680:Deglutition Disorders / Q000209:etiology / Q000534:rehabilitation / Q000628:therapy*; D004106:Dilatation; D016099:Endoscopy, Gastrointestinal / Q000009:adverse effects / Q000379:methods*; D004940:Esophageal Stenosis / Q000209:etiology / Q000628:therapy*; D005260:Female; D006258:Head and Neck Neoplasms / Q000628:therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010608:Pharyngeal Diseases / Q000209:etiology / Q000628:therapy*; D012189:Retrospective Studies; D016896:Treatment Outcome