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Rendezvous-Technik bei vollständiger Stenose des Hypopharynx

Indikation und Variationen der kombinierten Endoskopie

Rendezvous technique for complete hypopharyngeal stenosis

Indications and variations of combined endoscopy

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Zusammenfassung

Hintergrund

Die Ursachen für Hypopharynxstenosen sind vielfältig. Sie führen häufig zu Schluckunfähigkeit, Aspirationsneigung sowie dauerhaftem Angewiesensein auf die Versorgung über eine perkutane Gastrostomie (PEG-Sonde). Als Therapie stehen Bougierung, Dilatation, endoskopische Laserresektion, lokale Applikation von Mitomycin C und die offene Pharyngotomie mit Lappenplastik zur Verfügung.

Methoden

Wir berichten von 3 Fällen mit vollständiger Stenosierung des Hypopharynx bei unterschiedlicher Ätiologie. Es erfolgte die kombinierte retrograde Endoskopie in 3 Modifikationen mit anterograder laserchirurgischer Stenosenauftrennung unter diaphanoskopischer Kontrolle.

Ergebnisse

Mit Hilfe der sog. Rendezvous-Technik (kombinierte anterograde und retrograde Endoskopie) konnte in allen 3 Fällen mittels Diaphanoskopie und Laserresektion der Schluckweg wiederhergestellt werden.

Schlussfolgerungen

Bei komplexen Stenosen des Hypopharynx kann die Rendezvous-Technik mit ihren Modifikationen eine Möglichkeit der Wiederherstellung des Schluckwegs durch die Kombination von anterograder und retrograder Endoskopie als Alternative zu offenen chirurgischen Techniken bieten.

Abstract

Backround

Hypopharyngeal stricture can result from a number of causes including chemoradiotherapy and esophagectomy and leads to inability to swallow with aspiration as well as permanent dependence on a gastrostomy tube. Antegrade dilatation or puncture and local mitomycin C application are often unsuccessful and many patients require extensive surgery.

Methods

We report three cases of total hypopharyngeal stenosis with different clinical histories. We present our experience using three modifications of the combined anterograde-retrograde endoscopic technique with resection of the stenosis by laser technique under diaphanoscopic control.

Results

In all cases the hypopharyngeal-esophageal passage was restored. No complications occurred as a result of the procedure.

Conclusion

Combined direct hypopharyngoscopy with retrograde esophagoscopy represents a viable alternative to more extensive approaches for recanalization of selected obstructing hypopharyngeal stenoses when antegrade identification of the esophageal entrance fails.

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  1. HNO-Klinik und Poliklinik, Universitätsklinik Mainz, Langenbeckstraße 1, 55131, Mainz, Deutschland

    B. Pogorzelski, R. Kiesslich &  W. Mann

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  1. B. Pogorzelski
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  2. R. Kiesslich
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  3. W. Mann
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Correspondence to W. Mann.

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Pogorzelski, B., Kiesslich, R. & Mann, W. Rendezvous-Technik bei vollständiger Stenose des Hypopharynx. HNO 57, 781–788 (2009). https://doi.org/10.1007/s00106-009-1896-1

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