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.
Endoscopy_UCTN_Code_TTT_1AR_2AK
