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156 Koschny et al. | Journal of Clinical and Translational Research 2024; 10(2): 151-158

A localized synchronous squamous cell carcinomas of the esophagus
22 cm from the incisors and hypopharynx were treated by
definitive chemoradiotherapy [27]. Definitive radiochemotherapy
in our patient was, however, complicated by impaired wound
healing, esophageal necrosis, fistula formation, and osteomyelitis.
This study has several limitations. Despite the prospectively
B collected data, we had no well-defined criteria for which techniques
and material to be used, for the time intervals of bougienage and
the additive treatments. Long-term follow-up data are needed to
demonstrate a long-term benefit even in the two patients with the
best result reported in this series. Due to the rarity of this treatment
modality, we were only able to provide data on a very small
cohort. We propose to prospectively collect data in a multicenter
study designed with a predefined instrumental armamentarium,
treatment intervals, and outcome parameters.
Figure 4. Final outcome. (A) Endoscopic images showing Applying alternative endoscopic techniques like the per-oral
secondary squamous cell carcinoma 3.5 years after initial definitive endoscopic tunneling for recanalization of completely obliterated
radiochemotherapy of an oropharyngeal cancer, detected 495 days esophageal obstructions has been reported in literature [28-30].
after recanalization of pharyngo-esophageal obliteration. Radiotherapy Although this technique holds huge potential, it is very technically
resulted in esophageal wall necrosis with an open view of the spine after
metal implantation. (B) After 97 bouginages and balloon dilatations, demanding, and more investigations are warranted to validate its
patient #4 developed a therapy-induced esophago-tracheal fistula technical and clinical superiority over the rendezvous procedure.
(F - fistula, E - esophagus). 5. Conclusion

the seven cases reported in this series, only one direct complication Reestablishment of the pharyngoesophageal passage in patients
of the recanalization occurred but was managed conservatively. with complete obstruction after radiochemotherapy can be achieved
Despite a high initial technical success rate, the clinical success by a rendezvous technique of antegrade pharyngoscopy and
rate was quite low with a high percentage of additive invasive transgastric-retrograde esophagoscopy. However, these patients
measures and salvage operations. Although only a minority of require highly individualized treatment and follow-up with the
reported cases had achieved euphagia without further symptoms need for interdisciplinary, unconventional, and sometimes highly
(2/19, [18]; 6/24 [15]), most patients could at least consume experimental approaches to manage post-interventional obstacles.
semisolid food (11/19, [18]; 19/25, [4]; 11/25, [15]) or reported Despite successful recanalization, complete normalization of
an improvement of their dysphagia score [11]. A recent meta- the complex act of swallowing can only be expected in a small
analysis of 19 studies showed a technical success rate of 89%, but percentage of patients, and many patients might need repeated
a PEG-free improvement of dysphagia in only 58% [23]. In our interventions over many years. Thus, before implementing the
cohort, this rate was even lower, measuring only 14%. procedure, patients should be informed of the possibility of long-
Additional adhesions in the hypopharynx and larynx, pronounced term follow-up interventions. To avoid reocclusion and secondary
scar formation and propulsive dysfunction hamper a normal act malignancies, strict and continuous follow-up must be arranged
of swallowing even after successful treatment of esophageal for these patients.
strictures [24], and approximately 20% – 60% of patients are
still dependent on their PEG after recanalization [4,5,15,18,22]. Acknowledgments
Advanced laryngeal scar formation might hamper the well- The authors would like to thank the patients for their consent to
coordinated act of swallowing after recanalization. Concomitant share their clinical course with the scientific community.
intensive swallowing training is essential for clinical success.
In addition, in 43% of our patients, microsurgery with scar Funding
remodeling was necessary to restore the best possible anatomy
to facilitate food passage into the recanalized esophageal No funds, grants, or other support was received.
entrance. Argon plasma coagulation had been applied in some Conflict of Interest
cases to reduce excessive scars but might have contributed to the
esophagotracheal fistula which formed after 97 bouginages in The authors declare that they have no conflicts of interest.
patient #4, resulting in salvage laryngopharyngectomy. Therefore, Author Contributions
ablative techniques must be applied with utmost caution.
Tumor surveillance is an important management aspect for Conceptualization: Ronald Koschny, Gerhard Dyckhoff
hypopharyngeal cancer patients, as they often harbor risk factors Data acquisition/clinical care: All authors
for other malignancies [20,25,26]. In one recent case report, Original draft preparation: Ronald Koschny, Gerhard Dyckhoff
DOI: https://doi.org/10.36922/jctr.23.00116