経口・経胃瘻内視鏡下に閉塞を解除し得た中咽頭癌術後化学放射線療法後の咽頭食道閉塞例

<p>Pharyngo-esophageal stricture occurs as an adverse event after chemoradiation therapy for head and neck cancer, although complete obstruction is rare. The patient’s quality of life is impaired due to the difficulty in food intake and in swallowing saliva. Endoscopic balloon dilatation and stent insertion have been used for their treatment, but there is still no consensus on the optimal treatment. We report a case in which we were able to release the obstruction by inserting an endoscope through the mouth and the gastrostomy. The patient, a 47-year-old man, was diagnosed as having Stage III squamous cell carcinoma of the mesopharynx (T4N1M0). Because the result of induction chemotherapy was SD (stable disease), we performed tumor resection and administered postoperative chemoradiation therapy. Gastrostomy was performed because swallowing dysfunction was observed at the completion of the post operative radiation sessions. One year later, while imaging studies showed no recurrence of the disease, the swallowing function had not improved at all. We conducted video fluorography and gastroscopy to determine the cause, and detected pharyngo-esophageal obstruction. We attempted to release the obstruction endoscopically in the hope of preserving the vocal functions. We chose to use a dual approach via the mouth and the gastrostomy. The adhesion site of the pharynx and the esophagus was incised with a hook knife while observing from the gastrostomy side. The adhesions were dissected and the proximal and distal sides were opened. Balloon dilatation training was undertaken after the operation. The patient is now able to take liquids and semi-solid foods orally, but nutrition via the gastrostomy was continued. Clearing the obstruction did not completely resolve the dysphagia and treatment of the velopharyngeal insufficiency was necessary in this case. Therefore, the choice of treatment should be based on the wishes of the patient, clinical situation, and the nature of the treatment for the primary disease.</p>