150 / 412
Peng et al
there was no report of preintervention or postintervention
G-tube status. Ahlawat et al
24
performed dilation on 24
patients and reported technical success (endoscopic dilation
to 14 mm) in 19 patients and functional success (occasional
dysphagia to solid foods) in 18 patients. Again, G-tube sta-
tus was not available. Our technique improves on these out-
comes, however, as the rate of conversion from G-tube
dependence to predominantly oral nutrition—75% in our
study population—greatly exceeds the success rates
reported previously.
6,7,23,24
Furthermore, whereas others
have demonstrated good results (81% of patients maintain-
ing weight with oral diet) from dilation of the hypopharynx
and upper esophagus,
25
we have achieved these results
without complications and with serial dilations in the clinic
setting without general anesthesia.
Our use of the TNE accomplishes both diagnostic and
therapeutic purposes. Transnasal esophagoscopy is well tol-
erated in awake patients in the office setting, and we employ
the same scope in the operating room, which is beneficial
for consistency in assessing the degree of stenosis. Exposure
for rigid esophagoscopy may be quite difficult or impossi-
ble following CRT, and thus use of the flexible TNE
improves our ability to treat challenging cases. Some of the
residual esophageal lumens are quite small, and using the
5.1-mm TNE allows successful passage through the steno-
sis that is not always achieved with the larger gastroscopes.
Similarly, the small size allows retrograde passage through
the gastrostomy without requiring dilation, thus minimizing
morbidity; our results compare very favorably to another
series of 45 patients using the retrograde approach reporting
G-tube site morbidities in 7 of 63 (11%) procedures.
26
The
ability to perform transnasal esophagoscopy and dilation in
the office setting confers additional advantages, not in the
least that general anesthesia and its concomitant risks are
avoided.
Conclusion
Patients with esophageal stenosis after CRT can be success-
fully managed, with the majority achieving a full oral diet.
Transnasal esophagoscopy is an important tool in our arma-
mentarium of management of esophageal stenosis follow-
ing chemoradiation for head and neck cancer. The versatility
of transnasal esophagoscopy as an adjunct to esophageal
dilation, with either guidewire or balloon dilators, allows
for its use in both operative and office settings. As demon-
strated here, our algorithm is well tolerated, highly effec-
tive, and associated with little morbidity.
Declaration of Conflicting Interests
The author(s) declared no potential conflicts of interest with
respect to the research, authorship, and/or publication of this
article.
Funding
The author(s) received no financial support for the research,
authorship, and/or publication of this article.
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