[Stenoses and fistula in the high cervical esophagus: part I: therapy and stent implantation].

BACKGROUND: Treatment options for stenoses and fistula in the region of the high cervical esophagus or pharyngoesophageal junction are highly challenging. In the palliative setting or in the case of complications following surgery or radiotherapy, resignation often prevails. AIM: Based on own experiences with 204 patients with difficult stenoses and fistula in the high cervical region we saw encouraging results with endoscopic methods - in particular with stent implantation - which until now has been regarded as extremely problematic, or impossible, in this region.
RESULTS: In total, 192 high cervical stents were implanted in 149 patients; the upper margin of the stents was situated at 16.5 (8-25) cm. Technical/functional success of the implantation was achieved in 93% and 86%, respectively. The dysphagia score improved from 2.5 (2-3) to 1 (0-2). Fistula occlusion was achieved in 82%. A good or satisfying overall result after 3 months was observed in 75% of patients. During the follow-up-period (median 11 months) recurrent dysphagia occurred in 34% and recurrent fistula in 19%; both could be effectively treated in 87% of patients by combined endoscopic therapy (APC, dilatation and overstenting).
CONCLUSION: These figures show that, with careful diagnosis and indication as well as meticulous performance of a special technique for stent implantation (sink technique), an acceptable solution for a high percentage of these often disastrous situations can be found.