The DAVE Project - Gastroenterology

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Comments:
Problem: A 60-year old man was referred for management of post-cricoid (high) esophageal stricture following radiation for head and neck cancer.
Solution: Controlled repeated balloon dilation
Management: A slim endoscope is useful in the management of these patients. It is critical to perform dilation under fluoroscopic control. Since these patients require multiple dilations and are at a high risk of perforation it is important to counsel them about the management plan upfront. These patients benefit from a PEG tube for enteral feeding because it may take a number of weeks before the stricture could be dilated to an extent that allows adequate intake. Since these patients have a radiation induced damage to the strap muscles of the neck as well, one should encourage these patients to do daily neck muscle exercises. In addition, impaired salivary secretion from radiation damage to the glands may be stimulated by encouraging the patients to chew gum. These patients may require periodic dilation of the stricture to maintain the patency of esophageal lumen.

Contributed by:	Gottumukkala S. Raju, M.D. Director of Endoscopy Center for Endoscopic Research, Training and Innovation University of Texas Medical Branch
Citation: Raju, GS (Feb 17 2006). Esophagus - Endoscopic Management of High Esophageal Stricture. The DAVE Project. Retrieved Feb, 8, 2010, from http://daveproject.org/viewfilms.cfm?film_id=331 Times viewed since Feb 2006: 7399