Poor Functional Performance following Bidirectional Dilatation of Severe Postradiation Esophageal Stricture

Abstract

Objectives:

Assess the efficacy of bidirectional esophageal dilatation in the severely strictured esophagus induced by radiation therapy following the treatment of head and neck malignancies.

Methods:

Retrospective analysis of 5 patients who underwent bidirectional esophageal dilatation for esophageal stricture secondary to radiation therapy for head and neck malignancies over a 5-year period. The parameters of the primary tumor, evaluation of preoperative and postoperative esophageal dysfunction, and complications of the procedure were evaluated to assess its efficacy.

Results:

There were 9 episodes of bidirectional dilatation among 5 patients, 3 males and 2 females with a mean age of 63 years. Complete obstruction was demonstrated in 4 patients and severe obstruction was found in one patient during preoperative evaluation. The procedure was uneventful in all but 1 who was found to have postoperative mediastinitis due to microperforations, and healed completely. Four patients had persistent dysphagic symptoms despite post-dilatation video fluoroscopy failing to reveal any significant narrowing of the esophageal lumen.

Conclusions:

Combined anterograde and retrograde dilatation of severe chemoradiation-induced esophageal strictures is efficacious in improving luminal patency but ineffective in relieving functional dysphagia.