Complete hypopharyngeal stenosis is rare and challenging to treat 1 . A 72-year-old man underwent total laryngectomy with bilateral radical neck dissection, total thyroidectomy, and pectoralis major myocutaneous flap reconstruction to treat laryngeal cancer. Following adjuvant radiotherapy, the patient developed an hypopharyngeal stenosis. This was initially treated with endoscopic dilations. However, after 3 years, stricture recurrence led to complete obstruction of the hypopharyngeal lumen that required placement of a percutaneous endoscopic gastrostomy tube for nutrition. After failure of endoscopic ultrasound-guided recanalization 2 , an endoscopic magnetic compression anastomosis was attempted ( Video 1 ). To our knowledge, this approach, used to repair esophageal atresia in children 3 , has never been previously attempted in adults.
Video 1 Endoscopic magnetic compression anastomosis of a complete iatrogenic stenosis of the hypopharynx following surgery and radiation therapy for laryngeal cancer.
Following approval for compassionate care ( Fig. 1 ), two magnetic neodymium rings, with external and internal diameters of 9 mm and 3 mm, respectively, and length of 10 mm, were custom made (Cibas Srl, Milan, Italy) ( Fig. 2 ). A 6-mm diameter gastroscope was inserted through the gastrostomy site to reach the hypopharyngeal stenosis retrogradely and place a guidewire. The magnetic ring was advanced over the wire to the distal side of the stenosis, using the gastroscope as a pusher. The other magnetic ring was mounted onto a gastroscope using a distal attachment and inserted transorally in the hypopharynx. Fluoroscopy imaging monitored the attraction of the magnets, which stabilized at about 5 mm from each other.
Fig. 1.
Patient education material. a Physical model. b Illustration. PEG, percutaneous endoscopic gastrostomy.
Fig. 2.
Custom-made magnetic neodymium rings.
The patient was discharged after 24 hours of uneventful observation. Magnetic attraction was monitored by X-ray every 72 hours. Eleven days later the patient expelled the magnets through the mouth. Balloon dilations were performed every week for the first month, and every 2–4 weeks afterwards. At 9 months’ follow-up, the patient was able to eat solid foods.
Endoscopic magnetic compression anastomosis to treat a complete hypopharyngeal stenosis was feasible and effective. Endoscopic treatments of hypopharyngeal stenosis 4 5 may result in lower morbidity and mortality than surgical alternatives.
Endoscopy_UCTN_Code_CPL_1AH_2AF
Acknowledgments
The authors would like to thank Cibas Srl (Milan, Italy) for kindly donating the magnetic neodymium rings used in this study.
Footnotes
Competing interests Andrea Tringali is a consultant for Boston Scientific and Olympus. Ivo Boškoski is a consultant for Apollo Endosurgery, Boston Scientific, Cook Medical, Nitinotes, Endo Tools, Micro Tech and Pentax; research grant Apollo Endosurgery, advisory board member Endo Tools. Guido Costamagna receives consulting fees from Cook Medical, Olympus, Boston Scientific Corp.
Endoscopy E-Videos : https://eref.thieme.de/e-videos .
Endoscopy E-Videos is an open access online section, reporting on interesting cases and new techniques in gastroenterological endoscopy. All papers include a high quality video and all contributions are freely accessible online. Processing charges apply, discounts and wavers acc. to HINARI are available. This section has its own submission website at https://mc.manuscriptcentral.com/e-videos
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