%0 Journal Article
%T A Simple Combined Antegrade Radiological and Retrograde Endoscopic Procedure to Recanalise Fibrotic Hypopharyngo-Oesophageal Occlusions: Technical Description and Lessons from Clinical Outcome in Three Cases
%A Mohammed S. Miah
%A Ian A. Zealley
%A Afshin Alijani
%A Barry McGuire
%A Rodney E. Mountain
%A Suresh Mahendran
%J International Journal of Otolaryngology and Head & Neck Surgery
%P 179-185
%@ 2168-5460
%D 2013
%I Scientific Research Publishing
%R 10.4236/ijohns.2013.25038
%X <span style=\"font-family:Verdana;color:black;font-size:10pt;\">Background: </span><span style=\"font-family:'Times New Roman','serif';color:black;font-size:10pt;\"><span style=\"font-family:Verdana;\">Complete hypopharyngo-oesophageal occlusion is a rare complication of head and neck radiotherapy and a range of other conditions. Absolute dysphagia is accompanied by aspiration and dependence on gastrostomy feeding. The condition presents a substantial management challenge. Surgical approaches to re-establish pharyngo-oesophageal continuity are varied, highly invasive and are associated with unpredictable outcomes. Minimally invasive techniques employing endoscopic and radiological techniques are emerging. This report describes a multidisciplinary approach which translates two interventional radiology techniques used in the management of central venous occlusions and biliary strictures to the management of three cases of complete hypopharyngo-oesophageal occlusion. </span><span style=\"font-family:Verdana;\">Methods: </span><span style=\"font-family:Verdana;\">Three cases with different underlying aetiologies had treatment initiated between 2009 and 2011. Antegrade pharyngoscopic access to the occlusions was accompanied by retrograde endoscopic access via a small gastrostomy. Luminal continuity was re-established by the interventional radiology technique of ˇ°sharp recanalisationˇ± followed by passage of a wide bore nasogastric tube which was maintained in situ for 4-6 months, a duration of treatment analogous to that applied in the radiological management of fibrotic biliary strictures. After treatment a radiological contrast swallows examination was performed to gauge the calibre of the re-established lumen, assess functionality and to rule out aspiration. </span><span style=\"font-family:Verdana;\">Results: </span><span style=\"font-family:Verdana;\">Pharyngo-oesophageal continuity was re-established in all three cases on the first attempt. No complications occurred as a result of the procedures. In two cases, the excellent swallowing function was re-established, although one of these required prolonged post-treatment adjuvant interventions. In one case no swallowing function resulted, despite apparently successful re-establishment of luminal continuity. </span><span style=\"font-family:Verdana;\">Conclusions: </span><span style=\"font-family:Verdana;\">Complete fibrotic occlusion of the hypopharyngo-oesophageal lumen is rare and presents a substantial management challenge. A minimally invasive treatment combining antegrade radiological and retrograde
%K Hypopharynx
%K Upper Oesophagus
%K Fibrotic Occlusion
%K Rendezvous Technique
%K Pharyngo-Oesophageal Continuity
%U http://www.scirp.org/journal/PaperInformation.aspx?PaperID=36826