Therapeutic Options for Management of Pharyngoesophageal Corrosive Strictures

Abstract

In conclusion, pharyngoesophageal strictures require considerable expertise in management, and one should be aware of various options for this purpose. The choice of procedure depends on site of stricture, time of presentation after the corrosive injury, relationship of the stricture to the laryngeal inlet, status of the larynx and the airway, length of the stricture, presence or absence of a lumen distal to the stricture in the cervical esophagus, and presence or absence of strictures further downstream. With proper treatment, mortality is negligible and morbidity minimal and is usually restricted to temporary salivary fistula.

Corrosive Injury of the Upper Gastrointestinal Tract: A Review

“…Early attempts with pedicled cervical skin flaps were associated with a very high failure rate because of leakage and stricture. A myocutaneous flap harvested from the pectoralis major muscle and based on the pectoral branch of the acromiothoracic artery may be tunneled under the clavicle and sutured into a pharyngeal defect, but this flap is too bulky to be used for a circumferential defect [4,68]. Reconstruction is advisable at the end of the evolving scarring process, usually after 6 mo, although the optimal timing of reconstruction has been reported from 2 months to years [4,8,12,16,62,67].…”

“…Pharyngoesophageal strictures (PES) raise difficult therapeutic problems due to the site of stricture, the possible association with laryngeal injury and the presence of downstream esophageal strictures [68]. Reconstruction of a segment of the esophagus distal to the pharyngoesophageal junction and performance of anastomosis at this site is met with better results.…”

“…Reconstruction of a segment of the esophagus distal to the pharyngoesophageal junction and performance of anastomosis at this site is met with better results. Dilatation still remains the first choice therapeutic modality, although the failure rate of dilatation is higher as there is no lumen to enable passage of a guide wire for use of over-the-wire dilators [4,16,68]. When a balloon dilator is used, the extreme proximal nature of the stricture results in the proximal part of the inflated balloon occluding the larynx.…”

“…Once the lumen of the pharyngoesophageal stricture is stabilized, an esophagocoloplasty can be done through a left-sided neck approach. If the pharyngoesophageal stricture is the only segment of the esophagus to be narrowed, stabilization of the stricture by dilatation through an esophagostomy can be followed by asking the patient to progressively swallow liquids, semisolids and solids [68,72,73]. Patients with only synechiae between the arytenoids and the posterior pharyngeal wall benefit from repeated excision of the granulation tissue, cauterization, and adhesiolysis under anesthesia [1,12,68,72].…”

Endoscopic treatment of cicatricial esophageal strictures using ionized argon plasma (with commentary)

“…методиками, неэффективность дилатации выявляется в 10,4%, а рестенозирование -у 20-40% пролеченных больных [5,11,14,15].…”