title: Recurrent Complete Pharyngo-Oesophageal Stricture Treated by Multidisciplinary Anterograde-Retrograde Endoscopic Dilation.
abstract: Complete pharyngo-oesophageal stricture (PES) after radiotherapy for head and neck cancer is a relatively rare and difficult complication to manage. Historically this condition has been treated surgically, but endoscopic approaches are now available. We present a 61-year-old man with an epidermoid carcinoma of the supraglottic stage and a micro-invasive epidermoid carcinoma of the oropharynx treated surgically and subsequently by adjuvant radiotherapy. Eight months after the end of the radiotherapy, a complete PES was diagnosed and treated with a combined anterograde-retrograde endoscopic dilation (CARD). The procedure was performed using a transoral anterograde progression with a rigid pharyngoscope and a retrograde progression with an extra-slim nasal endoscope using the percutaneous gastrostomy already in place. Using both transillumination and direct visualisation from both sides of the complete stenosis patency was restored between the neopharynx and the oesophagus. Despite the use of an endoprosthesis, the complete PES recurred and the technique had to be performed a second time. Illustrating the complexity of the case different types of endoprosthesis and several dilations had to be performed for our patient to achieve and maintain a normal oral intake. This case report illustrates that even in complicated recurrent radiation-induced complete PES a CARD can be performed safely and successfully using different types of endoprosthesis.
authors.affiliation: Division of Gastroenterology and Hepatology, Department of Internal Medicine, Geneva University Hospital, Geneva, Switzerland.
authors.forename: Paulo Castro
authors.initials: PC
authors.lastname: Soares
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Geneva University Hospital, Geneva, Switzerland.
authors.forename: Salim
authors.initials: S
authors.lastname: Bouayed
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Geneva University Hospital, Geneva, Switzerland.
authors.forename: Pavel
authors.initials: P
authors.lastname: Dulguerov
authors.affiliation: Division of Gastroenterology and Hepatology, Department of Internal Medicine, Geneva University Hospital, Geneva, Switzerland.
authors.forename: Jean-Louis
authors.initials: JL
authors.lastname: Frossard
keywords: Anterograde-retrograde rendezvous technique; Combined anterograde-retrograde endoscopic dilation; Radiation-induced pharyngo-oesophageal strictures