Temporary placement of a fully covered self-expanding metal stent to allow therapeutic ERCP

A 64-year-old man with a previous history of laryngectomy followed by chemo- and radiotherapy was referred to us in January 2014 because of dysphagia. Endoscopy detected a 4-cm-long benign-appearing stricture in the hypopharynx (diameter 7 mm) and a 6-cm-long malignant circumferential lesion in the mid-esophagus (diameter 8 mm).

The patient was judged to be unfit for surgery, and therefore a fully covered self-expandable metal stent (FC-SEMS), 180 × 80 mm, was placed. Through-the-scope balloon dilation (CRE 10–11–12 mm; Microvasive, Boston Scientific Co., Natick, Massachusetts, United States) of the hypopharyngeal stricture was performed.

In February 2014 the patient developed a relapse of the hypopharyngeal stricture and jaundice due to compression of the common bile duct by the lymph nodes. Through-the-scope dilation of the stricture was performed, and a 14 × 16 × 100 mm FC-SEMS (Conio-Niti-S; Taewoong Medical, Seoul, Korea) was placed. The stent was removed 48 hours later immediately before therapeutic endoscopic retrograde cholangiopancreatography (ERCP). The duodenoscope could be easily inserted through the hypopharyngeal stricture, and ERCP revealed a 3-cm stricture (diameter 1 mm) of the common bile duct. A 60 × 10-mm biliary SEMS was placed at the biliary stricture.

Refractory hypopharyngeal stenosis is the most frequent long-term complication after laryngectomy followed by radiotherapy [1] [2]. A stricture in the proximal esophagus occurs in 10 % – 58 % of these patients [3]. Introduction of a dedicated and effective hypopharyngeal removable SEMS has changed the endoscopic therapy of these patients [4]. In this case, it enabled the endoscopic palliation of a biliary stricture, by allowing for the passage of the duodenoscope through a previously severely stenosed esophagus ([Video 1]).

Temporary placement of a fully covered, self-expandable, metal stent at an esophageal stricture enabled passage of the duodenoscope for therapeutic endoscopic retrograde cholangiopancreatography.

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• References

• 1 Jalisi M, Jalisi S. Advanced laryngeal carcinoma: surgical and non-surgical management options. Otolaryngol Clin North Am 2005; 38: 47-57
• 2 Nguyen NP, Moltz CC, Frank C et al. Severity and duration of chronic dysphagia following treatment for head and neck cancer. Anticancer Res 2005; 25: 2929-2934
• 3 Kronenberger MB, Meyers AD. Dysphagia following head and neck cancer surgery. Dysphagia 1994; 9: 236-244
• 4 Conio M, Blanchi S, Filiberti R et al. A modified self-expanding Niti-S stent for the management of benign hypopharyngeal strictures. Gastrointest Endosc 2007; 65: 714-720