stricture / throat stretching / surgical procedures

Will Brady

I am a friend and family member of a man who has survived the chemo/radiation treatments, but now has to live with an esophageal stricture. CT Scans have shown that the space allowing for food and liquids to pass can be as narrow as a couple of centimeters. On one spot, it is impossible to see where and how food passes through.
In March, the throat was stretched. It was, I believe the 4th time they had done this.
During that procedure, the wire that holds the different sized rings made a tear on the lining of the esophagus.
It took 24 hours (after x-rays and a CT Scan) before we learned the tear was NOT a puncture. Good thing.
Yesterday my friend went for a consult about a new stretch. The doctor was reluctant to perform it. Here's why:
Since the tear occurred before, the docs are hesitant to do it again. Frankly, they did not want to do it. One doc explained the risks of a new tear is high, as would be the risk of a puncture.
They noted that (and as he reports) he is able to eat soft foods; that he likes the liquid nutrition drinks and that his bloodwork and weight had improved dramatically since discharge from inpatient in April 2011.
So the conversation turned to surgery. They want at least one more CT Scan and more bloodwork done. Agreed to a surgery consult in August.
He asks about what surgery would be useful.
I have given him info on MIE, we have talked about laser surgery o reduce the size of the abnormal cell mass that causes the stricture, and asked about hyperbaric oxygen treatments.
Any other suggestions?

jojoshort

Just got back from the gastro consult as well
Hi Will,
We just returned ourselves from a gastro consult re possible stenting. I have read so much here about the stent and so was able to be the best advocate for my husband.
I won't be able to answer your question directly but will tell you what we decided.
My husband has Stage IVb (mets to lungs) and now has trouble, here and there, with food passing down the esophagus. The barium swallow showed about a 4-5" length of narrowing. His cancer is in the distal region, or lower esophagus. We talked about possible stenting and stretching. From our local guy, we heard that stretching may not be viable with such a long area that is constricted, but I of course would like a second opinion. We decided to do nothing yet. He can eat most of the time okay, sometimes has difficulty but is pain free the rest of the time. Stenting comes with a whole host of possible complications, such as stent migration, pain from the internal pressure, tumor ingrowth. We feel with us that since his quality of life is actually quite good, why fix what ain't totally broke? When we do decide it's a huge problem, we will visit Boston instead of staying local. I will say that if you are in an area with large teaching hospitals you may find more options than at your local gastroenterologist. Our guy, lovely as he is, has not performed many and so we will seek more experience further away.