High post radiation stricture

A 91 year old lady with SCC in upper third oesophagus was treated with radiotherapy with good relief of symptoms. 18 months later she represented with an undilatable stricture of the upper third of the oesophagus. Though no biopsy proven recurrence was demonstrated, it is probable that this was a combination of postradiation stricture with some tumour re-growth. The question was whether the stricture was too high for stenting.



Under radiological control the proximal extent of the tumour and the crico-pharyngeus were both marked (I find it easier with high strictures to place the patient supine on the Xray table as the markers are easier to position. Lower tumours are likely to be associated with reflux and aspiration during the procedure so I position them prone.)

A short (by my standards) 7cm Microvasive Ultraflex stent was placed across the stricture successfully. The lady was able to swallow a soft diet 4 hours after the procedure. An uncovered stent was used to minimise the chance of slippage. No dilatation was performed, again to minimise slippage. Dilatation can be perfomed later if necessary once the stent has "bedded in". In my experience the stents dilate spontaneously over a few days accompanied with some chest tightness, but do not usually need dilatation.