Workplace-based esophageal dilation in head and neck most cancers: Security, feasibility, and value evaluation.
Laryngoscope. 2018 Feb 08;:
Authors: Howell RJ, Schopper MA, Giliberto JP, Collar RM, Khosla SM
OBJECTIVE: To evaluate expertise, security, and value of office-based esophageal dilation in sufferers with historical past of head and neck most cancers (HNCA).
METHODS: The medical data of sufferers present process esophageal dilation within the workplace have been retrospectively reviewed between August 2015 and Could 2017. Sufferers got nasal topical anesthesia. Subsequent, a transnasal esophagoscopy (TNE) was carried out. If the affected person tolerated TNE, we proceeded with esophageal dilation utilizing Seldinger method with the CRE™ Boston Scientific (Boston Scientific Corp., Marlborough, MA) balloon system. Sufferers have been discharged immediately from the outpatient clinic.
RESULTS: Forty-seven dilations have been carried out in 22 sufferers with a median of two.1 dilations/affected person (vary 1-10, normal deviation [SD]?±?2.2). Seventeen sufferers (77%) have been male. The common age was 67 years (vary 35-78 years, SD?±?eight.5). The most typical major website of most cancers was oral cavity/oropharynx (n?=?10), adopted by larynx (n?=?6). All sufferers (100%) had historical past of radiation remedy. 4 sufferers have been postlaryngectomy. The indication for esophageal dilation was esophageal stricture and progressive dysphagia. All dilations occurred within the proximal esophagus. There have been no main problems. Three focal, superficial lacerations occurred. Two sufferers skilled gentle, self-limited epistaxis. One dilation was poorly tolerated on account of discomfort. One affected person required ache treatment postprocedure. Workplace-based esophageal dilation generated $15,000 much less in well being system fees in comparison with conventional working room dilation on common per episode of care.
CONCLUSION: In sufferers with historical past of HNCA and radiation, office-based TNE with esophageal dilation seems secure, well-tolerated, and cost-effective. In a small cohort, the method has low complication price and is possible in an otolaryngology outpatient workplace setting.
LEVEL OF EVIDENCE: four. Laryngoscope, 2018.
PMID: 29417586 [PubMed – as supplied by publisher]